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Pharmacy

WellCare of New Jersey 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.  

Coverage Determination

The coverage determination process enables providers to request an addition or exception.

Medication Appeals

Providers may appeal a coverage determination decision by contacting our Pharmacy Appeals department via fax, mail, in person or phone. Please refer to the Quick Reference Guide for instructions.

Preferred Drug List (PDL)

The Preferred Drug List contains information about drugs covered by the plan. Please check back for updates, as PDLs are periodically amended. Search for a drug using our online tool, or view or print the PDL.

Printed Preferred Drug Lists

Pharmacy Forms

Pharmacy Clinical Policies

Hydroxyprogesterone caproate (Makena®/compound) is a progestin.

Eculizumab (Soliris®) is a complement inhibitor.

Mogamulizumab-kpkc (Poteligeo®) is a CC chemokine receptor type 4 (CCR4)-directed monoclonal antibody.

The following are factor VIII products requiring prior authorization: human – Hemofil M®, Koate-DVI®; recombinant – Advate®, Adynovate®, Afstyla®, Eloctate®, Esperoct®, Helixate FS®, Jivi®, Kogenate FS®, Kogenate FS with Vial Adapter®, Kogenate FS with Bio-Set®, Kovaltry®, NovoEight®, Nuwiq®, Obizur®, Recombinate®, ReFacto®, Xyntha®, and Xyntha® Solofuse™.

Factor VIIa, recombinant (NovoSeven® RT) and coagulation factor VIIa (recombinant)-jncw (SevenFact®) are coagulation factors.

AbobotulinumtoxinA (Dysport®) is an acetylcholine release inhibitor and a neuromuscular blocking agent.

IncobotulinumtoxinA (Xeomin®) is an acetylcholine release inhibitor and a neuromuscular blocking agent.

OnabotulinumtoxinA (Botox®) is an acetylcholine release inhibitor and a neuromuscular blocking agent.

RimabotulinumtoxinB (Myobloc®) is an acetylcholine release inhibitor and a neuromuscular blocking agent.

Eteplirsen (Exondys 51™) is an antisense oligonucleotide.

Ocrelizumab (Ocrevus™) is a CD20-directed cytolytic antibody.

Cerliponase alfa (Brineura®) is a hydrolytic lysosomal N-terminal tripeptidyl peptidase.

Edaravone (Radicava™) is a member of the substituted 2-pyrazolin-5-one class that acts as a free-radical scavenger of peroxyl radicals and peroxynitrite.

Testosterone pellet (Testopel®) is an implantable androgen. Testosterone undecanoate (Jatenzo®) is an oral androgen.

Tisagenlecleucel (Kymriah™) is a CD19-directed, genetically modified, autologous T-cell immunotherapy.

Axicabtagene ciloleucel (Yescarta™) is a CD19-directed, genetically modified, autologous T-cell immunotherapy.

Voretigene neparvovec-rzyl (Luxturna™) is an adeno-associated virus vector-based gene therapy.

Ibalizumab-uiyk (Trogarzo™) is a CD4-directed post-attachment human immunodeficiency virus type 1 (HIV-1) inhibitor.

Patisiran (Onpattro™) is a double-stranded small interfering ribonucleic acid, formulated as a lipid complex for delivery to hepatocytes.

Ravulizuamb-cwvz (Ultomiris®) is a complement inhibitor.

Caplacizumab-yhdp (Cablivi®) is a von Willebrand factor (vWF)-directed antibody fragment.

Elapegademase-lvlr (Revcovi®) is a recombinant adenosine deaminase.

Onasemnogene abeparvovec (Zolgensma®) is an adeno-associated virus (AAV) vector-based gene therapy.

Trientine (Syprine®) is a chelating agent.

Crizanlizumab-tmca (Adakveo®) is a selectin blocker.

Golodirsen (Vyondys 53TM) is an antisense oligonucleotide.

Inebilizumab-cdon (Uplizna ™ ) is an anti-CD19 monoclonal antibody.

Belantamab mafodotin (Blenrep®/™ ) is an anti-B-cell maturation antigen (BCMA) monoclonal antibody and microtubule inhibitor conjugate.

Other Helpful Information

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.
  • 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.


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Last Updated On: 3/30/2021
Wellcare Medicare and PDP is getting a new look! Be on the lookout for changes in the coming months and know you can still count on the great coverage you’ve come to expect. Meet the New Wellcare. ×