Medicaid Managed Care & HealthierLife Oncology Medications Prior Authorization List
Defines drugs and HCPCS/CPT/Q-code products that require prior authorization review by Evolent for Fidelis Care Medicaid Managed Care & HealthierLife members (adults; pediatric included starting 7/1/2022). Lists out-of-scope items that should not be submitted and a comprehensive list of HCPCS/CPT/J-codes and Q-codes requiring review.
No material clinical/coverage changes.
Coverage Summary
Defines drugs and HCPCS/CPT/Q-code products that require prior authorization review by Evolent for Fidelis Care Medicaid Managed Care & HealthierLife members. Coverage stance: covered with criteria — oncology medications and supportive agents require Evolent review prior to dispensing or administration.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.