Access key forms for authorizations, claims, pharmacy and more.
Form must be completed in full, and used only when submitting 1 refund check per claim.
This list includes the most commonly prescribed medications that were on the 2016 formulary and their preferred 2017 alternatives.
Please complete ALL FIELDS and fax this form to WellCare’s Pharmacy Department at 1-866-388-1767.
Fill out and submit this form to request prior authorization (PA) for your Medicare prescriptions.
Fill out and submit this form to request an appeal for Medicare medications.
Care of Older Adult Assessment Form
Appendix 7 - Waiver of Liability Statement (Rev. 105, Issued: 04-20-12, Effective: 04-20-12, Implementation: 04-20-12)