What is a comprehensive formulary?
A comprehensive formulary is a list of drugs covered by Wellcare and posted for you to review. We work with health care providers to create our formulary. This list includes 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. The formulary search tool also includes formulary alternatives that may help lower your drug costs. If you have questions about our formulary, or if your medication is not listed, please use the Contact Us form.
To view the downloadable formulary, drug search tool, or details about Prior Authorization and Step Therapy, please visit the Drug List (Formulary) and Other Documents page on this website.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 or call 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 rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
How can I save money with Wellcare?
- Fill your prescription through CVS/Caremark medication home delivery pharmacy.
You can fill your prescription at any Wellcare network pharmacy. However, if you fill your prescription through CVS/Caremark mail-service pharmacy that offers preferred cost-sharing, you could pay less. Visit the Medicare section of the Help Center and see "How do I start receiving my prescriptions through mail service delivery?" to learn more.
- Switch to our preferred generic drugs
Ask your doctor if any of your drugs are available as a generic, and if the generic version would work for you. Generic medications are FDA-approved, have the same active ingredients, indications, dosages, safety and strengths as the brand name medications and generally cost less.
For certain drugs you or your provider need to get approval from Wellcare before we will agree to cover the drug for you. This is called “prior authorization”. If you do not get this approval, your drug might not be covered by the plan. Drugs that require prior authorization are noted with “PA” or “PA-NS” on the downloadable formulary and in the search tool.
For certain drugs Wellcare requires you to first try certain drugs to treat your medical condition before another drug will be covered. This requirement to try a different drug first is called “step therapy.” Drugs that require step therapy are noted with “ST” on the downloadable formulary and in the search tool.
For certain drugs, the drug amount Wellcare will cover is limited. Drugs with quantity limits are noted with "QL" on the downloadable formulary and in search tool.