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Pharmacy Services

What Are Medically Necessary Drugs?

Medically necessary drugs are drugs you need to get and stay well. As required by NJ FamilyCare, WellCare covers such drugs. We also use a Preferred Drug List (PDL). These are the drugs that we want your doctor use. The drugs on the PDL are sorted by brand and generic name. They are also sorted by quantity, gender and age limits.

Search for a Drug

Printed Preferred Drug Lists

Drugs that Require Prior Approval (and are not on our PDL)

Your provider must send us a Coverage Determination Request (CDR). We also allow a drug store to give you a 72-hour supply of a drug (on or not on our PDL) that needs a prior approval.

There are some medicines we will not cover. They include:

  • Those used for eating problems or weight gain
  • Those used to help you get pregnant
  • Those used for erectile dysfunction
  • Those that are for cosmetic purposes or to help you grow hair
  • DESI (Drug Efficacy Study Implementation) drugs and drugs that are identical, related or similar to such drugs
  • Investigational or experimental drugs
  • Those used for any purpose that is not medically accepted

Drug Evaluation Request Forms


NJ FamilyCare Plan Documents

Fill out and submit this form to request prior authorization (PA) for your Medicaid prescriptions.

Fill out and submit this form to request an appeal for Medicaid medications.

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Last Updated On: 6/24/2019