WellCare Medicare - Medication Guide

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.

Use our online tool to quickly look up drugs:

    South Florida Only

    All other service areas*

* Connecticut, Florida (except South Florida), Georgia, Illinois, Indiana,  Louisiana, Missouri, New Jersey, New York, Ohio, Texas

Or download the entire formulary for your state or region:

• View formulary for Connecticut with No GAP, SNP, and the updates.
• View formulary for Florida with GAP, NO GAP, SNP and the updates.
• View formulary for South Florida only with GAP, NO GAP, SNP, and the updates. 
• View formulary for Georgia with GAP, NO GAP, SNP, and the updates.
• View formulary for Illinois with GAP, NO GAP and the updates.
• View formulary for Indiana with GAP, NO GAP, SNP, and the updates.
• View formulary for Louisiana with GAP, NO GAP, SNP, and the updates.
• View formulary for Missouri with GAP, NO GAP, SNP, and the updates.
• View formulary for New Jersey with GAP, NO GAP, SNP, and the updates.
• View formulary for New York with GAP, NO GAP, and the updates.
• View formulary for Ohio with GAP, NO GAP, SNP, and the updates.   
• View formulary for Texas with GAP, NO GAP, SNP, and the updates. 

 

View WellCare's Transition Policies.

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 put together a network of over 60,000 pharmacies. You can take your prescription to any one of these network pharmacies and get your medication filled. Typically, most members get their prescriptions filled at one of our network pharmacies. On occasion, members may have to use a pharmacy that is not enrolled in WellCare’s network to get their prescriptions filled due to an emergency or other unforeseen circumstance. WellCare will only cover drugs filled at an out-of-network pharmacy in limited circumstances when a network pharmacy is not available. These include illness and if you are traveling outside of WellCare’s service area where there is no network pharmacy.

Example: You go on vacation and get sick while on vacation. You receive a prescription and get it filled at the local pharmacy. Unfortunately, you have to pay full cost of the medication because the pharmacy is not a WellCare network pharmacy. When you return from vacation, you may submit a Direct Member Reimbursement form for possible reimbursement.

In addition, you may be required to pay the difference between what you would pay for a prescription filled at an in-network pharmacy and what the out-of-network pharmacy charged for your prescriptions.

You can request a Direct Member Reimbursement form by calling Customer Service or you can  download a copy of the form and instructions on how to complete it. Please make sure to complete the form (including your signature) and attach all necessary pharmacy receipts. WellCare will accept a pharmacy printout (in lieu of the pharmacy receipts), but the medication that you are requesting reimbursement for must be notated on the printout. Once you have completed the form, please mail it along with a copy of your prescription receipt(s) to the following address: WellCare, Reimbursement Department, P.O. Box 31577, Tampa, FL 33631-3577.

Reimbursement usually takes four to six weeks from the date you mail in the Direct Member Reimbursement Form. Be sure that your form is completed and all necessary information is attached. Otherwise, your request may be delayed. Formulary guidelines will apply to all reimbursement requests.

If you have any questions, please contact Customer Service .

Last modified: 07/30/2008