Wellcare Value Script (PDP)

Prescription Drug Claim Form

Complete this form to request reimbursement for covered prescription drugs that you paid full price for.

• English
• Spanish

Covered Diabetes Testing Supplies

Preferred diabetes testing supplies list (blood glucose meters and test strips) you can receive from an in-network pharmacy for plan year 2024.

• English

Request for Medicare Prescription Drug Coverage Determination

Complete this printable form to ask us for a decision about a prescription drug and your specific plan coverage. Members should fax form to 1-866-388-1767.

• English