Medication Guide

What is a formulary?

A formulary is a list of prescription drugs covered by our Plan. WellCare covers prescription drugs in every Medicare-approved category including most Part D drugs.

Both the formulary search tool and downloadable formulary will provide you with drug details and formulary alternatives that may help lower your drug costs. If you have questions about our formulary or if your medication is not listed, contact us.
 

Can the formulary change?

The formulary may change during the year.  View our formulary updates.
 

What are generic drugs?

WellCare covers both brand name and generic drugs.  Generic drugs have the same active-ingredient formula as a brand name drug.  Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) as safe and effective as brand name drugs.

For other descriptions of prescription drug terms, view our glossary of terms.
 

How can I save money with WellCare?
 

• Switch to our preferred generic drugs - WellCare offers $0 co-pays on preferred generic drugs in our WellCare Signature (PDP) and $0 co-pays on preferred generic drugs in our WellCare Classic (PDP) in most regions. Ask your doctor about our preferred generic drugs to see if they are right for you.
• Use Exactus Pharmacy Solutions, WellCare's preferred mail service pharmacy - you may save 17% on a 3-month supply of medications while having your prescriptions delivered directly to your door! Best of all, using our preferred mail service provider can help you stay out of the Medicare coverage gap.
  
  *This savings occurs when you use Exactus Pharmacy Solutions, WellCare's preferred mail service pharmacy as compared to using a non-preferred mail service pharmacy.
   

Are there any restriction on my coverage?

2012   Prior Authorization: WellCare requires you or your physician obtain prior authorization for certain drugs.  This means you will need approval from WellCare before you fill your prescriptions.  If you do not get approval, WellCare may not cover the drug.   Drugs that require prior authorization are flagged with "PA" on both the downloadable formulary and search tool.
 

Quantity Limits: For certain drugs, WellCare Limits the drug amount WellCare will cover.  Drugs with quantity limits are flagged with "QL" on both the downloadable formulary and search tool.
 

2012  Step Therapy: In some cases, WellCare requires you first try specific drugs to treat your medical condition before we will cover another drug for that condition.  Drugs that require step therapy are flagged with "ST" on both the downloadable formulary and search tool.
 

View our Drug Utilization Management and Quality Assurance practices.

View information on our Medication Therapy Management program.

View our information on coverage determinations, exceptions, appeals and grievances.