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Pharmacy

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)

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.

Preferred Drug Lists & Medication Guide


A preferred drug list is a list of drugs covered by your plan.

This is a list of recent changes to the preferred drug list.

The Over the Counter Catalog includes a detailed list of available items from allergy medications to sunblock to vitamins. It also includes easy instructions on how to order.

This list includes behavioral health preferred drugs and dosage recommendations.

This list includes behavioral health drug coverage information.

Coverage Determination Requests

Request a coverage decision and/or exception or file an appeal of a drug coverage decision.

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

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.
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Last Updated On: 12/21/2015