Skip to main content

Coverage Determination Request

Request a Coverage Decision

You may request a coverage decision and/or exception any of the following ways:

WellCare, Pharmacy-Coverage Determinations
P.O. Box 31397
Tampa, FL 33631-3397

  • Call: Refer to your Medicare Quick Reference Guide for the appropriate phone number.

Basis for Requests

This process ensures that medication regimens that are high risk, have a high potential for misuse or have narrow therapeutic indices are used appropriately and according to FDA-approved indications. Providers may request an addition or exception for:

  • Drugs not listed in the Formulary
  • Duplication of therapy
  • Prescriptions that exceed the FDA daily or monthly quantity limit
  • Most self-injectable and infusion medications 
  • Drugs that have an age edit
  • Drugs listed on the PDL but still requiring Prior Authorization (PA)
  • Brand name drugs when a generic exists
  • Drugs that have a step edit (ST) and the first-line therapy is inappropriate
Contact Us icon

Need help? We're here for you.

Contact Us
Last Updated On: 4/13/2022
Our login portals are currently under maintenance. You may experience intermittent outages with login and registration. We are sorry for any problems this may cause. Thank you for your patience as we work to improve our systems ×