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Coverage Determination Request

Request a Coverage Decision

You may request a coverage decision and/or exception any of the following ways:

WellCare, Pharmacy-Coverage Determinations
P.O. Box 31397
Tampa, FL 33631-3397

Basis for Requests

This process ensures that medication regimens that are high risk, have a high potential for misuse or have narrow therapeutic indices are used appropriately and according to FDA-approved indications. Providers may request an addition or exception for:

  • Drugs not listed in the Formulary
  • Duplication of therapy
  • Prescriptions that exceed the FDA daily or monthly quantity limit
  • Most self-injectable and infusion medications 
  • Drugs that have an age edit
  • Drugs listed on the PDL but still requiring Prior Authorization (PA)
  • Brand name drugs when a generic exists
  • Drugs that have a step edit (ST) and the first-line therapy is inappropriate
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Last Updated On: 12/4/2020
WellCare will be performing maintenance on Saturday, September 18, 2021 at 6pm EST until Sunday, September 19, 2021 at 6am EST. You might not be able to access systems or fax during this time. We are sorry for any issues this may cause. Thank you for your patience. If you need assistance, contact us. ×