How can I join?
Call the New York Enrollment Broker:
1-855-600-FIDA (Toll-free)
TTY/TDD 1-888-329-1541
Participant Services:
1-844-861-FIDA (3432), TTY/TDD: 711

Prior Authorization Forms

SWH Whole Health FIDA Plan requires you, or your physician, to get prior authorization for certain drugs. This means that you will need to get approval from us before you fill your prescriptions. If you don't get approval, we may not cover the drug.

Download the Drug Coverage Determination Form (PDF) in ENGLISH.

Download the Drug Coverage Determination Form (PDF) in SPANISH.

Download the Drug Coverage Determination Form (PDF) in CHINESE.

The following document provides a list of drugs that require Prior Authorization. The Prior Authorization Forms are appropriate for use by both SWH Whole Health Plan participants and providers.

Effective November 1, 2018

Download the SWH Whole Health FIDA Plan 2018 Prior Authorization Criteria (PDF).

2019 Prior Authorization Criteria

Download the SWH Whole Health FIDA Plan 2019 Prior Authorization Criteria (PDF).


Last Updated 11/22/2018

H8851_2015_099 Approved 12/18/2014