The WellCare Pharmacy Services team is committed to quality service and partnership with our providers to improve our members' health and well-being. To help your patients get the most out of their pharmacy benefit.
Preferred Drug List (PDL)
Printed Preferred Drug Lists
- WellCare of New York Medicaid Preferred Drug List
- New York Medicaid Machine Readable File
- WellCare of New York Notice of Change
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.
Most medications are covered without prior authorization. However, the PDL denotes a range of coverage limitations to promote appropriate use of utilization management tools to particular drugs, when applicable.
Materials may change over time so check back to ensure you have the most up-to-date version.
Note: Durable medical equipment (DME) and medical supplies are reviewed and, as applicable, approved, through WellCare's DME Services. Diabetic supplies, including meters, strips, lancets and alcohol swabs, are covered by Pharmacy Services. Refer to the Quick Reference Guide for contact information.
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
Pharmacy Utilization Management Tools
Our pharmaceutical management procedures are integral in 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 is not on the PDL, 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.
Other Helpful Information
Exactus Specialty Pharmacy
VFC Vaccine Billing
Vaccines available through the VFC Program are not billable to NYS Medicaid regardless of whether or not the vaccine was obtained through the VFC Program.