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Coverage Determination Request

You may request a coverage decision and/or exception any of the following ways:
  
- Online: Request Prescription Drug Coverage using our online form.
- FaxComplete a coverage determination request This PDF document will open in a new window. and fax it to 1-866-388-1767.
- MailComplete a coverage determination request This PDF document will open in a new window. and send it to:

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

For Overnight Requests:

WellCare, Pharmacy-Coverage Determinations
8735 Henderson Road, Ren. 4
Tampa, FL 33634

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

Injectable Infusion

For coverage determination requests, please use the WellCare Injectable Infusion form This PDF document will open in a new window..

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
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Last Updated On: 5/9/2016
On September 1, 2018, our premium payment services changed. These changes will make it easier for you to pay your premium. Read more. ×