Pharmacy Services
What Are Medically Necessary Drugs?
Medically necessary drugs are drugs you need to get and stay well. As required by NJ FamilyCare, Fidelis Care covers such drugs. We also use a Preferred Drug List (PDL). These are the drugs that we want your doctor use. The drugs on the PDL are sorted by brand and generic name. They are also sorted by quantity, gender and age limits.
Printed Preferred Drug Lists
The following Medication-assisted treatment (MAT) products are preferred and can be found on our Formulary to treat Substance Use Disorder(s) (SUD):
| Product Name | Maximum Daily Dose |
| ACAMPROSATE 333 MG DELAYED RELEASE TABLET | 6 Tablets |
| BUPRENORPHINE 2 MG TABLET SUBLINGUAL | 16 Tablets |
| BUPRENORPHINE 8 MG TABLET SUBLINGUAL | 4 Tablets |
| BUPRENORPHINE-NALOXONE 2-0.5 MG TABLET | 16 Tablets |
| BUPRENORPHINE-NALOXONE 8-2 MG TABLET | 4 Tablets |
| BUPRENORPHINE-NALOXONE 2-0.5 MG FILM | 16 Tablets |
| BUPRENORPHINE-NALOXONE 4-1 MG FILM | 8 Tablets |
| BUPRENORPHINE-NALOXONE 8-2 MG FILM | 4 Tablets |
| BUPRENORPHINE-NALOXONE 12-3MG FILM | 2.67 Tablets |
| DISULFIRAM 250 MG TABLET | |
| DISULFIRAM 500 MG TABLET | |
| NALOXONE 0.4 MG/ML VIAL | |
| NALOXONE 2 MG/2 ML SYRINGE | |
| NALOXONE 4 MG/10 ML VIAL | |
| NALOXONE HCL 4 MG NASAL SPRAY | |
| NALTREXONE 50 MG TABLET | |
| NARCAN 4 MG NASAL SPRAY | |
| SUBLOCADE 100 MG/0.5 ML SYRINGE | |
| SUBLOCADE 300 MG/1.5 ML SYRINGE | |
| VIVITROL 380 MG VIAL-DILUENT+ |
+Must be atleast 18 years of age. Limited to 1 Vial per 28 days.
This information can be found on the New Jersey Medicaid Preferred Drug List (PDF) listed above in the Printed Preferred Drug List section. Please see the complete Formulary for additional information.
Drugs that Require Prior Approval (and are not on our PDL)
Your provider must send us a Coverage Determination Request (CDR). We also allow a drug store to give you a 72-hour supply of a drug (on or not on our PDL) that needs a prior approval.
There are some medicines we will not cover. They include:
- Those used for eating problems or weight gain
- Those used to help you get pregnant
- Those used for erectile dysfunction
- Those that are for cosmetic purposes or to help you grow hair
- DESI (Drug Efficacy Study Implementation) drugs and drugs that are identical, related or similar to such drugs
- Investigational or experimental drugs
- Those used for any purpose that is not medically accepted
Drug Evaluation Request Forms
2026 Step Therapy Exception Decisions
| Month/Year | Total Exception Requests | Total Exception Requests Approved | Total Exception Requests Denied | Percent of Exceptions Granted |
| January - 26 | 1019 | 483 | 536 | 47% |
| February - 26 | 989 | 447 | 542 | 45% |
| March - 26 | 1207 | 559 | 648 | 46% |
| April - 26 | 1165 | 523 | 642 | 45% |
| May - 26 | 1102 | 494 | 608 | 45% |
| June - 26 | 1181 | 488 | 693 | 41% |
This information is made available pursuant to New Jersey Assembly Bill 1825.
Step therapy exceptions may be requested via our existing medical exceptions process. Refer to the section above, “Drug Evaluation Request Forms.”
| Month/Year | Total Exception Requests | Total Exception Requests Approved | Total Exception Requests Denied | Percent of Exceptions Granted |
| August - 25 | 1015 | 441 | 574 | 43% |
| September-25 | 1095 | 444 | 651 | 41% |
| October - 25 | 1229 | 508 | 721 | 41% |
| November - 25 | 891 | 408 | 483 | 46% |
| December - 25 | 979 | 496 | 483 | 51% |
This information is made available pursuant to New Jersey Assembly Bill 1825.
Step therapy exceptions may be requested via our existing medical exceptions process. Refer to the section above, “Drug Evaluation Request Forms.”