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Medicare Health Plans Information
Drug Utilization Management and Quality Assurance
Need to know if your medications are covered by your WellCare plan? Our Medication Guide, or formulary, is a list of brand-name and generic drugs covered by our prescription drug plans. It is developed with help from pharmacists and physicians from both within and outside the company.

Need more information?

  • Drug Utilization Management and Quality Assurance, click here.
  • Tiered cost sharing and how to obtain an exception request, click here.

If your drug is not covered, we have great alternatives that can help you save money on prescriptions. To learn more about these alternatives or if you cannot find your prescription, please call us at:
1-800-960-2530, TTY/TDD users should call 1-877-247-6272
Monday - Friday, 8:00 a.m. - 6:00 p.m. Eastern Time.

WellCare covers both brand name drugs and generic drugs.

Generic: 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.

Preferred brand drugs: Among brand drugs, these are the ones WellCare prefers.

Non-preferred brand drugs: These drugs are not on the WellCare preferred list. You can continue to use these drugs with any WellCare plan, but you may pay more.

Non-covered drugs: These drugs are not covered by any WellCare plan.

Out-of-network pharmacy coverage

WellCare has formed a network of pharmacies. You must use a network pharmacy to receive plan benefits. WellCare may not pay for your prescriptions if you use an out-of-network pharmacy, except in certain cases.

Covered Part D drugs are available at out-of-network pharmacies in special circumstances including illness while traveling outside of the Plan's service area where there is no network pharmacy. In this situation you will have to pay the full cost rather than just your co-payment when you fill your prescription. In addition, you may be required to pay the difference between what we would pay for a prescription filled at an in-network pharmacy and what the out-of-network pharmacy charged for your prescriptions. You can ask us to reimburse you for our share of the cost by submitting a paper claim.



Last modified: 03/21/2007
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