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Utilization Management Tools and Specialty Pharmacy

Pharmacy Utilization Management Tools

Our pharmaceutical management procedures are integral to using the most clinically appropriate agent(s) to improve the health and well-being of our members. To request an evaluation of a pharmaceutical that has an age edit, exceeds established quantity limits, is a brand name when a generic exists, or requires a prior authorization or step edit, please submit a Prior Authorization Request for Prescriptions. Additional request forms can be accessed on the Forms page.

Expedited requests and an emergency supply of medication will be completed within 24 hours. Refer to the Quick Reference Guide for Pharmacy Services contact information. In the event your non-emergency Drug Evaluation Review request is denied, you can appeal.

Specialty Pharmacy

WellCare offers a network that includes qualified specialty pharmacies with expert service in the special handling, storage and administration of medications for members who have long-term, life-threatening or rare conditions.

You can find pharmacies using our Find a Provider pharmacy search tool.

One of these pharmacies includes Exactus Speciality Pharmacy, which is WellCare's specialty pharmacy. For a detailed list of conditions covered and how to use Exactus Specialty Pharmacy, please visit our Exactus Specialty Pharmacy page.

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Last Updated On: 3/15/2017