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Pharmacies

Network Pharmacies

Wellcare is accepted at over 60,000 network pharmacies nationwide. This makes it easy for you to get your drugs. Our network includes major chains, independent retail pharmacies, mail order service pharmacies, long-term care, home infusion and Indian Health Service/Tribal/Urban Indian Health Program pharmacies.

As a member, you may fill your prescriptions at any network pharmacy. When you fill your prescription, simply present your Wellcare Member ID card.

For more information about filling your prescriptions at network pharmacies, please refer to your Evidence of Coverage.

Mail Order Service

For certain kinds of prescription drugs, you can use our preferred mail order service –CVS Caremark®. You have the choice to get up-to-a 90-day supply of your drugs shipped directly to your home discreetly and free with standard delivery. This can save you time, money, and trips to the pharmacy.

For more information, please visit our Mail Order Service page located on this website. You may also call CVS Caremark® Member Services at 1-866-808-7471 (TTY: 711) 24 hours a day, 7 days a week.

Out-of-Network Pharmacies

We have thousands of pharmacies in our nationwide network to make it easy to get your drugs. However, we know there may be times when you can't use a network pharmacy. We may cover your drugs filled at an out-of-network pharmacy if:

  • There isn’t a network pharmacy that is close to you and open, or
  • You need a drug that you can’t get at a network pharmacy close to you, or
  • You need a drug for emergency or urgent medical care, or
  • You must leave your home due to a federal disaster or other public health emergency

Always contact Member Services first to see if there is a network pharmacy near you.

If you take a drug(s) on a regular basis and are planning to travel, be sure to check your supply of the drug(s) before you leave. When possible, take along all the drugs you will need. If you travel within the United States and territories, we may cover your drug at an out-of-network pharmacy for the same reasons as noted above. However, we cannot pay for any prescriptions filled by pharmacies outside of the United States and territories, even for medical emergency.

If you must use an out-of-network pharmacy, you generally will have to pay the full cost instead of a copay when you fill your prescription. You can ask us to pay you back for our share of the cost.

How do you ask for reimbursement from us?

  1. Complete the Prescription Claim Form below.
  2. Attach the original prescription receipt to the form. If you do not have the original receipt, you can ask your pharmacy for a printout. Do not use cash register receipts. It is also a good idea to make a copy of your bill and receipts for your records.
  3. Mail the completed form and receipt to the address on the form. You must submit your claim to us within three years of the date you received your drug.

Prescription Claim Form - English This PDF document will open in a new window.

After we receive your request, we will mail our decision (coverage determination) with a reimbursement check (if applicable) within 14 days. 

For specific information about drug coverage, please refer to your Evidence of Coverage or Contact Us. 
We are here to help.

Pharmacy Information

Request for Medicare Prescription Drug Determination: Electronic Form

OR

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.

Request for Medicare Prescription Drug Determination This PDF document will open in a new window.

Request for Redetermination of Medicare Prescription Drug Denial (Appeal):
Electronic Form

OR

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. Request for Redetermination of Medicare Prescription Drug Denial (Appeal) This PDF document will open in a new window.

Learn More

Learn more about coverage determinations and exceptions on the Centers for Medicare & Medicaid Services website.

Filling Your Prescription

When you fill your prescription at a participating pharmacy, you will simply need to present your Wellcare ID card. You will be responsible for any necessary out-of-pocket expense according to your Part D benefit. 

Learn how to fill your prescriptions through our preferred Mail Order Pharmacy.

Did you fill a prescription at a pharmacy outside our network? Learn more about our out-of-network coverage.

Refer to the Evidence of Coverage for information on your share of the prescription cost.

Mail Order Pharmacy

CVS Caremark Mail Order Pharmacy is Wellcare's preferred mail order pharmacy. You will be able to receive up to a three-month supply of your medication right to your door.

AcariaHealth Specialty Pharmacy

Why should I use AcariaHealth Specialty Pharmacy?

Wellcare's preferred specialty pharmacy services are available at no additional cost to members who are taking medication to treat long-term, life-threatening or rare conditions. Our platform of services includes helping members to manage side effects and symptoms, order refills, learn how to better administer medications and more.

  • Coverage Determination and Redetermination Forms

    Request for Medicare Prescription Drug Determination: Electronic Form

    OR

    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.

    Request for Medicare Prescription Drug Determination This PDF document will open in a new window.

    Request for Redetermination of Medicare Prescription Drug Denial (Appeal):
    Electronic Form

    OR

    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. Request for Redetermination of Medicare Prescription Drug Denial (Appeal) This PDF document will open in a new window.

    Learn More

    Learn more about coverage determinations and exceptions on the Centers for Medicare & Medicaid Services website.

  • Filling Your Prescription

    Filling Your Prescription

    When you fill your prescription at a participating pharmacy, you will simply need to present your Wellcare ID card. You will be responsible for any necessary out-of-pocket expense according to your Part D benefit. 

    Learn how to fill your prescriptions through our preferred Mail Order Pharmacy.

    Did you fill a prescription at a pharmacy outside our network? Learn more about our out-of-network coverage.

    Refer to the Evidence of Coverage for information on your share of the prescription cost.

  • Mail Order Pharmacy

    Mail Order Pharmacy

    CVS Caremark Mail Order Pharmacy is Wellcare's preferred mail order pharmacy. You will be able to receive up to a three-month supply of your medication right to your door.

  • AcariaHealth Specialty Pharmacy

    AcariaHealth Specialty Pharmacy

    Why should I use AcariaHealth Specialty Pharmacy?

    Wellcare's preferred specialty pharmacy services are available at no additional cost to members who are taking medication to treat long-term, life-threatening or rare conditions. Our platform of services includes helping members to manage side effects and symptoms, order refills, learn how to better administer medications and more.


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Y0020_WCM_87476E Last Updated On: 6/13/2022