CurrentFidelis CarePolicy N/A
Medicare Wellcare by Fidelis Care Oncology Medications and Supportive Agents Review Requirements
Requires review by Evolent (formerly New Century Health/NCH) for participating providers before oncology medications and supportive agents are dispensed at a pharmacy or administered in outpatient/ambulatory settings for members of all ages; includes lists of HCPCS/CPT/J-codes and pharmacy-only NDC/J-code groupings requiring review and preferred biosimilars. Out-of-scope categories are listed.
Policy Summary
PayerFidelis Care
PolicyMedicare Wellcare by Fidelis Care Oncology Medications and Supportive Agents Review Requirements
Policy CodePolicy N/A
Change TypeClarified; Revised (operational contact)
Effective Date11/01/2023
Next Review Date
Key ActionParticipating providers must submit all oncology medication and supportive agent requests, including the entire oncology regimen, to Evolent/New Century Health prior to dispensing or administration; non-participating providers must fax submissions to plan at 1-844-235-5090 effective 10/1/2023.
SourceLink
POLICY UPDATE CHANGES
Effective 11/1/2023 for Wellcare by Fidelis Care - list of HCPCS/J-codes and pharmacy mappings requiring review.
Fax number for non-participating providers updated to 1-844-235-5090 effective 10/1/2023.
100+HCPCS/J/Q codes listed
Section A & BBenefit scope
11/01/2023Effective date on code lists