Pharmacy

WellCare is committed to working with providers to improve members' health and well-being. The following information will help your patients get the most out of their pharmacy benefits.  

Preferred Drug Lists

The PDL is a clinical guide of prescription drug products selected by WellCare's Pharmaceutical and Therapeutics (P&T) Committee based on a drug's efficacy, safety, side effects, pharmacokinetics, clinical literature and cost-effectiveness.

• Staywell MMA Dual Eligible
• Children's Medical Services

Florida Agency for Health Care Administration (AHCA)

• AHCA Pharmacy Page
• AHCA Preferred Drug List
• Drug Criteria
• Summary of Drug Limitations  

Coverage Determination Requests

Request a coverage decision and/or exception or file an appeal of a drug coverage decision.

• Electronic Prior Authorization (ePA): Surescripts Prior Authorization Portal
• Online: Request Prescription Drug Coverage
• Fax or Mail: Complete a request for prescription drug coverage.
• Electronic Prior Authorization (ePA): Through their ongoing collaboration, WellCare and Surescripts have partnered to provide free ePA services for all your WellCare patients.

Medication Appeals

You may appeal a coverage determination decision by contacting our Pharmacy Appeals Department. Please complete a medication appeal request.

• Online: Request Appeal for Drug Coverage using our online form
• Fax or Mail: Complete an appeal of coverage determination request.