Have questions about which drugs are covered under your WellCare plan? Find your plan to view the comprehensive formulary.
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What is a formulary?
A formulary is a list of covered drugs believed to be a necessary part of a quality treatment program. WellCare works with a team of health care providers to create this list and to make sure we cover a full range of medications that our members need. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a WellCare network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.
Both the formulary search tool and downloadable formulary will provide you with drug details that may help lower your drug costs. If you have questions about our formulary or if your medication is not listed, please contact us.
What is a comprehensive formulary?
A comprehensive formulary includes the entire list of drugs covered by WellCare and is posted for you to review.
Can the formulary change?
The formulary may change during the year. To get updated information about the drugs covered by WellCare, please see the most recently posted formulary or call Customer Service.
What are generic drugs?
WellCare covers both brand-name drugs 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) to be as safe and effective as brand-name drugs.
For other descriptions of prescription drug terms, please view our glossary of terms.
How can I save money with WellCare?
- Fill your prescription at any of WellCare’s Network Retail Pharmacies *– WellCare plans offer lower co-payments for Preferred Generic (Tier 1) drugs when you have them filled at any of our Network Pharmacies (retail and mail-service) that offer preferred cost-sharing. Network pharmacies include Duane Reed, K-Mart, Kroger, Sam’s Club, Walgreens and WalMart.
- Switch to our preferred generic drugs – Ask your doctor or pharmacist if generics may be right for you. Generic medications are FDA-approved and have the same active ingredients, indicators, dosage, safety, and strength as the brand-name medication.
* Other pharmacies are available in our network.
Are there any restrictions on my coverage?
Prior Authorization English Spanish
WellCare requires you or your physician to 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 noted 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 noted with "QL" on both the downloadable formulary and search tool.
Step Therapy English Spanish
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 noted with "ST" on both the downloadable formulary and search tool.
- Transition Policy in case your medication isn't covered.
- Drug Utilization Management and Quality Assurance practices.
- Medication Therapy Management program.
- Information on how to obtain coverage determinations, exceptions, appeals and grievances.
Y0070_NA027271_PDP_WEB_ENG CMS Approved