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Drug List (Formulary) and Other Documents

Have questions about which medications are covered by your plan? Access your formularies here or search a drug via the search tool.

Drug Search Tool

Search a Drug via the Search Tool

Printed Formulary

Comprehensive Formulary This PDF document will open in a new window.

Comprehensive Formulary (Spanish) This PDF document will open in a new window.

Notice of Change

Notice of Change This PDF document will open in a new window.

Notice of Change (Spanish) This PDF document will open in a new window.

Prior Authorization

Prior Authorization This PDF document will open in a new window.

Prior Authorization (Spanish) This PDF document will open in a new window.

Step Therapy

Step Therapy This PDF document will open in a new window.

Step Therapy (Spanish) This PDF document will open in a new window.

Pharmacy Forms

Members can complete this form to order prescriptions from CVS Caremark Mail Service Pharmacy, WellCare's preferred mail-order pharmacy.

This document outlines your rights with regards to your Medicare drug plan.

Use this printable form to ask us for a decision about a prescription drug and your specific plan coverage. Providers and members should fax form to 1-866-388-1767.

Complete this printable form to ask for an appeal after being denied a request for coverage or payment for a prescription drug. This is the same form as above but cannot be submitted electronically.

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Y0070_WCM_42183E Last Updated On: 10/1/2019