Important Information About Your Prescription Drug Coverage in 2026
Wellcare Prescription Drug Plans (PDP) appreciates the opportunity to provide you with your Medicare Part D prescription drug benefits. As your prescription drug provider, we want to ensure you’re aware that a transition fill for a medication you currently take has been utilized for 2026. We offer this one-time temporary supply to members when a medication is not covered on our formulary or is subject to other quantity or authorization requirements.
Action needed before you run out of your medication:
Start by talking with your provider or pharmacist now to avoid any interruption in therapy. Your provider can help identify which option meets your treatment needs.
- Option 1: Switch to a formulary alternative. The alternatives are listed in our formularies when using the Drug Search Tool.
- Option 2: If the formulary alternatives are not suitable for you, you or your provider can submit a coverage determination (CD) demonstrating you meet our criteria to have the coverage approved or an exception to our formulary requirements. This CD must be approved before your pharmacy can process future medication fills.
If you have already switched to an alternative or submitted a coverage determination – please disregard the this information.
Are there any alternative medications that I should consider?
You can find the alternatives by viewing our 2026 list of alternative covered drugs (PDF). If your medication is not listed, then you can visit our Drug Search Tool for your plan and search for your medication by typing in your medication name.
How can a coverage determination be submitted?
Below are the ways you or your provider can submit a coverage determination. Please note, we will need supporting information from your provider.
- You can ask your provider to submit digitally via an electronic prior authorization (ePA). Your provider must include statements supporting this request.
- Submit a request using our online form.
- You can print the form (PDF) and take it to your provider. The completed form can be submitted one of two-ways:
- Your provider can fax 1-866-388-1767
- You or your provider can mail it to:
Pharmacy – Coverage Determinations
PO Box 31397
Tampa, FL 33631
- You may also ask for a coverage determination by utilizing our chat feature on the member portal or by phone at 1-888-550-5252 (TTY: 711).
Once your coverage determination has been reviewed, you will receive a letter with the outcome. If approved, you will be able to process the medication at your pharmacy under your Wellcare PDP benefit.
When will this affect me?
Once you have used your transition fill in 2026, you will need to submit a coverage determination and receive approval if you would like to continue this medication.
How long will it take to know the decision of the coverage determination?
Wellcare PDP is committed to a 72-hour response time for a standard decision once we receive the needed information from your provider. However, if you are in a situation where without your medication there can be potential harm to your life, health, or ability to regain maximum function, you may ask for an expedited (fast) decision.
Why is my request for coverage denied?
If your request for coverage is denied, you have the right to appeal by asking for a review of the prior decision which is called a redetermination. You must request this appeal within 60 calendar days from the date of our written decision on your coverage determination request. We accept standard requests by phone and in writing. We accept expedited requests by phone and in writing.
Attn: Medicare Pharmacy Appeals
PO Box 31383
Tampa, FL 33631-3383
Fax Number: 1-866-388-1766
Phone Number: 1-888-550-5252 (TTY: 711)
Have additional questions? We’re here to help!
You can chat live with a representative in our Member Portal or call us at 1-888-550-5252 (TTY: 711). Representatives are available to take your call from 8 a.m. to 8 p.m. every day between October 1 and March 31 and from 8 a.m. to 8 p.m. Monday through Friday between April 1 and September 30.
"Wellcare" is issued by WellCare Prescription Insurance, Inc.
