Medicare : Medication Guide
- New Jersey
- New York
What is a formulary?
A formulary is a list of covered drugs selected by WellCare in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. WellCare will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a WellCare network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.
Both the formulary search tool and downloadable formulary will provide you with drug details and formulary alternatives that may help lower your drug costs. If you have questions about our formulary or if your medication is not listed, contact us.
What is a comprehensive formulary?
A comprehensive formulary includes the entire list of drugs covered by WellCare and is posted for you to review.
Can the formulary change?
The formulary may change during the year. To get updated information about the drugs covered by WellCare, please see the most recently posted formulary on this website (by clicking your state name on the list at the top of this page) or by calling Customer Service.
What are generic drugs?
WellCare covers both brand-name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand-name drug. Generic drugs usually cost less than brand-name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand-name drugs.
For other descriptions of prescription drug terms, view our glossary of terms.
How can I save money with WellCare?
- Fill your prescription at any of WellCare’s Preferred Retail Pharmacies* – WellCare plans offer lower co-pays for Preferred Generic (Tier 1) drugs when you have them filled at any of our Preferred Retail Pharmacies, including Duane Reed, K-Mart, Sam’s Club, Walgreens, and WalMart.
- Switch to our preferred generic drugs – Ask your doctor if generics may be right for you. Generic medications are FDA-approved and have the same active ingredients, indicators, dosage, safety, and strength as the brand-name medication and generally costs less.
- Use Exactus Pharmacy Solutions, WellCare's preferred mail-service pharmacy* - With Exactus Pharmacy Solutions, you can have your medications delivered directly to your door and pay $0 for a 3-month supply of Preferred Generic (Tier 1) mediations. For all other, non-specialty (Tier 5) medications, you pay two co-pays for a three month supply. Standard shipping is free! Best of all, using our preferred mail-service pharmacy can help you stay out of the Medicare coverage gap.
* Other pharmacies are available in our network.
Are there any restrictions on my coverage?
WellCare requires you or your physician to obtain prior authorization for certain drugs. This means you will need approval from WellCare before you fill your prescriptions. If you do not get approval, WellCare may not cover the drug. Drugs that require prior authorization are noted with "PA" on both the downloadable formulary and search tool.
For certain drugs, WellCare limits the drug amount WellCare will cover. Drugs with quantity limits are noted with "QL" on both the downloadable formulary and search tool.
In some cases, WellCare requires you first try specific drugs to treat your medical condition before we will cover another drug for that condition. Drugs that require step therapy are noted with "ST" on both the downloadable formulary and search tool.
Transition Policy in case your medication isn't covered.
Drug Utilization Management and Quality Assurance practices.
Medication Therapy Management program.
Information on how to obtain coverage determinations, exceptions, appeals and grievances.
Y0070_NA023899_WCM_WEB_ENG CMS Approved
Last modified: 01/01/2014