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.

Florida Agency for Health Care Administration (AHCA)

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.

Exactus Specialty Pharmacy

The WellCare Specialty Pharmacy offers expert service in the special handling, storage and administration of medications for members who have long-term, life-threatening or rare conditions. With its knowledge of the insurance process and plan benefits, the team can speedily help the patient receive his or her medication. For a detailed list of conditions covered, please visit our Exactus Specialty Pharmacy page.

Medical Injectables

WellCare's medical injectables' prior authorization requirements are aligned with current industry practice. Most self-injectable and infusion medications require prior authorization. Use our authorization look-up tool to search quickly and easily by CPT code.

Exactus Specialty Pharmacy

Exactus Specialty Pharmacy
The WellCare Specialty Pharmacy offers expert service in the special handling, storage and administration of medications for members who have long-term, life-threatening or rare conditions. With its knowledge of the insurance process and plan benefits, the team can speedily help the patient receive his or her medication. For a detailed list of conditions covered, please visit our Exactus Specialty Pharmacy page.
Medical Injectables

Medical Injectables
WellCare's medical injectables' prior authorization requirements are aligned with current industry practice. Most self-injectable and infusion medications require prior authorization. Use our authorization look-up tool to search quickly and easily by CPT code.