Medicaid Formulary and Q2 Updates
Medicaid, Child Health Plus, and Healthier Life:
Formulary Changes and Effective Dates
Fidelis Care has made changes to our Medicaid Managed Care, Child Health Plus (CHP), and HealthierLife (HARP) Formulary effective April 1, 2022. Some of the changes relate to quantity limitations, authorization requirements, as well as drugs being removed and added to the formulary. Please see the full list here.
| Drug
|
Action
|
Effective Date
|
| Buprenorphine/Naloxone (Zubsolv)**
|
• Add with QL
|
03/22/2022
|
| Buprenorphine/Naloxone film (Suboxone)**
|
• Add generic with QL (Brand already Formulary)
|
03/22/2022
|
| Naloxone (Kloxxado)**
|
• Add
|
03/22/2022
|
| Memantine ER
|
• Add with ST of memantine IR
|
04/01/2022
|
| Procrit/Epogen
|
• Add with PA
|
04/01/2022
|
| Ruconest
|
• Add with PA
|
04/01/2022
|
| Cinryze
|
• Add with PA
|
04/01/2022
|
| Invega Hafyera
|
• Add with PA
|
04/01/2022
|
| Teriflunomide (Aubagio)
|
• Add QL
|
04/01/2022
|
| Ambrisentan (Letairis)
|
• Add QL
|
04/01/2022
|
| Fingolimod (Gilenya)
|
• Add QL
|
04/01/2022
|
| Sponimod (Mayzent)
|
• Add QL
|
04/01/2022
|
| Sponimod (Mayzent) Titration Pack
|
• Add with QL
|
04/01/2022
|
| Actemra*
|
• Add with PA/QL
|
04/01/2022
|
| Stelara*
|
• Add with QL
|
04/01/2022
|
| Buprenorphine/Naloxone (Zubsolv)**
|
• Add with QL
|
04/01/2022
|
* Change for CHP Only; Change will not affect NYM/HARP
** Change for NYM/HARP Only; Change will not affect CHP