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Pharmacy

WellCare of North Carolina 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 Request

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

  • Online: Request Prescription Drug Coverage
  • Fax or Mail: Complete a request for prescription drug coverage.

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.

  • Online: Request Appeal for Drug Coverage 
  • Fax or Mail: Complete an appeal of coverage determination request.

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.

Printed Preferred Drug Lists

Additional Information

Exactus Specialty Pharmacy Information

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 Information

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 Information

    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 Information

    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: 12/13/2020