Fidelis Care would like to inform you of key changes in medication coverage with regards to prescription drug benefits.
Effective October 1, 2011, pharmacy benefits will be changing from New York Medicaid to Fidelis Care. Fidelis Care will now be providing both medical and prescription drug benefits to previous New York Medicaid members. Members will be receiving a new Fidelis Care ID as well as a letter to inform them of the medication coverage changes. As of October 1, 2011, the new Fidelis Care card will be required to fill prescriptions. The Medicaid benefit card will no longer be active for prescriptions after September 30, 2011.
Fidelis Care has a list of covered drugs (formulary or preferred drug list) and the majority of the drugs on our formulary will be the same as the current New York State Medicaid formulary. However, there will be certain changes and not every drug will be covered. To prevent any disruptions in member care, please review the most recent Fidelis Care Preferred Drug List which is available at www.fideliscare.org. If a drug is not on the Preferred Drug List then you should contact your primary care provider so that preferred medications may be selected. The amount of copayments for your drug benefits will remain the same.
Fidelis Care does not cover certain family planning and reproductive health services, such as abortion, sterilization, and prescription birth control. As required by the State of New York, a Medicaid member can use their Medicaid card to receive these services from any doctor, clinic, or drug store that accepts Medicaid. For any questions regarding these non-covered services, you may contact the New York State Growing Up Healthy Hotline at 1-800-522-5006.
For additional information, please refer to the list of frequently asked questions. You may also visit our Web site at www.fideliscare.org or contact Member Services at 1-888-FIDELIS (1-888-343-3547).
Thank you for your cooperation. We look forward to continue working with you to provide patients and our members with quality, cost-effective care.
Frequently Asked Questions
Question: What changes will take place on October 1, 2011?
Answer: Starting October 1, 2011, your pharmacy benefit will be provided by Fidelis Care. You must use your new Fidelis Care pharmacy benefit card to receive your prescriptions.
Question: What information do I have to present to the pharmacy to fill my prescriptions?
Answer: You should bring your new Fidelis Care pharmacy benefit card to the pharmacy to receive your prescriptions. You will be receiving your new card in the next few weeks.
Question: What date will these changes take effect?
Answer: The changes will take effect on October 1, 2011, so you have time to get a prescription for a new medication from your doctor.
Question: Will I still be able to use my Medicaid benefit card when I drop off a prescription at the pharmacy?
Answer: No, you will need to present your Fidelis Care pharmacy benefit card to a pharmacist when you fill a new prescription or refill the existing one as of October 1, 2011.
Question: What happens if I am taking a medication that will no longer be covered?
Answer: Tell your doctor's office that you received this letter so that you can get new prescriptions for one of the preferred formulary medications. Take your new prescriptions to your local pharmacy to be filled. Remember, you must do this before October 1, 2011.
Question: What if I want to keep taking my non-formulary medication after October 1, 2011?
Answer: Discuss this with your doctor. You will be allowed a one-time only transitional fill of your medication if you are unable to contact your doctor and change to a preferred medication. After that temporary fill, you or your pharmacist will need to talk to your doctor about changing to a covered drug or your doctor can ask the plan to let you continue taking the same drug.
Question: Where can I find a list of medications that are on Fidelis Care formulary?
Answer: You can see the most recent formulary version at www.fideliscare.org.
Question: What will my copays be?
Answer: Your copays for drugs will remain the same.
Question: Who do I contact if I have more questions?
Answer: You may go to the Fidelis Care Web site at www.fideliscare.org, or call Member Services at 1-888-FIDELIS (1-888-343-3547) Monday through Friday from 8:30AM to 6PM.
Question: What if the pharmacy I fill my prescriptions at does not accept Fidelis Care members?
Answer: This is very rare. However, if you find you have to change your current pharmacy to a network pharmacy that serves Fidelis Care members, you can locate in-network pharmacies on the Fidelis Care Web site at www.fideliscare.org using the provider search tool.
Question: Will I be allowed a 90-day supply of my medication under the new coverage?
Answer: No, as is consistent with most prescription benefits, Fidelis Care will allow a maximum of a 30-day supply.