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A formulary is a list of covered drugs. We select the drugs by working with a team of health care providers. The list contains the prescription medications we believe are a necessary part of a quality treatment program.

We generally cover the drugs listed in our formulary as long as:

  1. The drug is medically necessary
  2. The prescription is filled at a WellCare network pharmacy
  3. Other plan rules are followed.
Can the Formulary Change?

In general, if members are taking a drug on our 2018 formulary that was covered at the beginning of the year, we will not stop or reduce coverage of the drug during the 2018 coverage year.

However, there are some cases when we may stop or reduce coverage. These are:

  • When a new, less expensive generic drug becomes available
  • When new negative information about the safety or effectiveness of a drug is released.

Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. For those members, it will remain available at the same cost share for the remainder of the coverage year. We think it’s important that members continue to get the formulary drugs that were available when they chose our plan for the remainder of the coverage year. The only exceptions are for cases in which they may save additional money or we can ensure their safety.

2018 Formularies

2019 Formularies

Downloadable 2019 Formulary TableThis PDF document will open in a new window.

Use the links in this table to go to the formularies:

2018

Plans

Formulary ID

Plan Type

Formulary URL

PDP Plans Select

18443

Classic

http://client.formularynavigator.com/Search.aspx?siteCode=3119159574

PDP Plans
Extra

18439

Extra

http://client.formularynavigator.com/Search.aspx?siteCode=1417410309

PDP Plans Value Script

18442

Value Script - AZ, LA, OR, WA, WI

http://client.formularynavigator.com/Search.aspx?siteCode=1420391585

Essential - MAPD

18437

Choice, Plus, RX - IL only
Value - AR, CT, FL, IL, LA, KY, NJ, TN, TX
Essential, Preferred, Dividend, Dividend Prime - CT, FL, KY, MS, TN, TX
Access - CT, HI, LA, NJ, TX
Liberty - CT, HI, LA, NJ, TX

Premier and Guardian - FL only

http://client.formularynavigator.com/Search.aspx?siteCode=1423559190

Essential - MAPD

18437

Easy Choice Freedom - CA only

http://client.formularynavigator.com/Search.aspx?siteCode=1691273869


Essential - MAPD


18438

Choice, Essential, Preferred, Premier, Value - NY and CT
RX - CT only

http://client.formularynavigator.com/Search.aspx?siteCode=1696304771

5T Standard - MAPD

18435

Choice, Essential, and Value - GA, NC, SC, TN
Premier - GA and SC only
Prime - GA and SC only

http://client.formularynavigator.com/Search.aspx?siteCode=1698727057

Core with Supplemental (Viagra) on Tier 2

18436

Easy Choice Plus - CA only

http://client.formularynavigator.com/Search.aspx?siteCode=1701149344

Core with Supplemental (Viagra) on Tier 2 and additional gap coverage on Tier 1

18436

Easy Choice Best - CA only

http://client.formularynavigator.com/Search.aspx?siteCode=1703757960

Core with additional gap coverage on Tier 1

18436 Easy Choice Best - CA only

http://client.formularynavigator.com/Search.aspx?siteCode=1820116050
Generic Strategy Standard

18441
Access, Liberty, Select AR, FL, GA, KY, MS, NC, NY, SC, TN
RX - AR and TN only
Value - MS only

http://client.formularynavigator.com/Search.aspx?siteCode=1822724666

2019

State

Contract-PBP

Formulary Book Number

Plan Name

Formulary Template Description

Formulary Search Tool

TX

H0174002000

6

WellCare TexanPlus Classic (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 6

TX

H0174003000

5

WellCare TexanPlus Classic (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 5

CT

H0712019000

18

WellCare Value (HMO)

Generic Strategy Standard MAPD

FST - 18

IL

H1416009000

5

WellCare Value (HMO-POS)

Generic Strategy Core MAPD w/ Modifications

FST - 5

NY

H2775100000

18

WellCare Today's Options Advantage Plus 750B (PPO)

Generic Strategy Standard MAPD

FST - 18

NY

H2775101001

18

WellCare Today's Options Advantage Plus 550B (PPO)

Generic Strategy Standard MAPD

FST - 18

NY

H2775101002

18

WellCare Today's Options Advantage Plus 550B (PPO)

Generic Strategy Standard MAPD

FST - 18

ME

H2775101003

18

WellCare Today's Options Advantage Plus 550B (PPO)

Generic Strategy Standard MAPD

FST - 18

NY

H2775103001

18

WellCare Today's Options Advantage Plus 550B (PPO)

Generic Strategy Standard MAPD

FST - 18

ME

H2775103002

18

WellCare Today's Options Advantage Plus 550B (PPO)

Generic Strategy Standard MAPD

FST - 18

NY

H2816019000

5

WellCare Today's Options Premier Plus 650B (PFFS)

Generic Strategy Core MAPD w/ Modifications

FST - 5

TX

H5656001000

6

WellCare TexanPlus Classic (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 6

NY

H0088001000

18

WellCare Premier (PPO)

Generic Strategy Standard MAPD

FST - 18

GA

H0111001000

11

WellCare Premier (PPO)

Core MAPD w/ Modifications

FST - 11

GA

H0111002000

11

WellCare Prime (PPO)

Core MAPD w/ Modifications

FST - 11

TX

H0174001000

6

WellCare TexanPlus Star (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

TX

H0174004000

6

WellCare Access (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

TX

H0174005000

5

WellCare Value (HMO-POS)

Generic Strategy Core MAPD w/ Modifications

FST - 5

TX

H0174006000

6

WellCare Liberty (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

TX

H0174007000

6

WellCare Dividend Prime (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 6

AR

H0270001000

6

WellCare Premier (PPO)

Generic Strategy Core MAPD w/ Modifications

FST - 6

CT

H0712005000

6

WellCare Access (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

CT

H0712020000

6

WellCare Rx (HMO-POS)

Generic Strategy Core MAPD w/ Modifications

FST - 6

CT

H0712021000

17

WellCare Preferred (HMO)

Generic Strategy Standard MAPD

FST - 17

NC

H0712022000

14

WellCare Value (HMO)

Core MAPD w/ Modifications

FST - 14

NC

H0712023000

14

WellCare Value (HMO)

Core MAPD w/ Modifications

FST - 14

NC

H0712024000

14

WellCare Value (HMO)

Core MAPD w/ Modifications

FST - 14

NC

H0712025000

6

WellCare Access (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

CT

H0712028000

6

WellCare Liberty (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

NJ

H0913002000

6

WellCare Value (HMO-POS)

Generic Strategy Core MAPD w/ Modifications

FST - 6

NJ

H0913013000

20

WellCare Liberty (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 20

NJ

H0913015000

6

WellCare Rx (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 6

FL

H1032032000

12

WellCare Dividend (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032040000

16

WellCare Dividend (HMO)

Core MAPD w/ Modifications

FST - 16

FL

H1032061000

6

WellCare Select (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

FL

H1032073000

12

WellCare Value (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032079000

12

WellCare Value (HMO-POS)

Core MAPD w/ Modifications

FST - 12

FL

H1032091000

12

WellCare Essential (HMO-POS)

Core MAPD w/ Modifications

FST - 12

FL

H1032124000

6

WellCare Access (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

FL

H1032133000

12

WellCare Value (HMO-POS)

Core MAPD w/ Modifications

FST - 12

FL

H1032170000

6

WellCare Access (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

FL

H1032174000

12

WellCare Essential (HMO-POS)

Core MAPD w/ Modifications

FST - 12

FL

H1032175000

6

WellCare Liberty (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

FL

H1032176000

6

WellCare Liberty (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

FL

H1032182000

6

WellCare Select (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

FL

H1032184000

9

WellCare Guardian (HMO SNP)

Core MAPD w/ Modifications

FST - 9

FL

H1032186000

10

WellCare Guardian (HMO SNP)

Core MAPD w/ Modifications

FST - 10

FL

H1032187001

12

WellCare Dividend (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032187002

12

WellCare Dividend (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032188001

12

WellCare Dividend (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032188002

12

WellCare Dividend (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032189000

12

WellCare Dividend Prime (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032190000

12

WellCare Elite (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032191000

12

WellCare Dividend Prime (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032192000

12

WellCare Elite (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032193000

12

WellCare Dividend Prime (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032194000

12

WellCare Elite (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032195000

12

WellCare Dividend Prime (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032196000

16

WellCare Elite (HMO)

Core MAPD w/ Modifications

FST - 16

FL

H1032197000

6

WellCare Reserve (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

FL

H1032198000

12

WellCare Dividend Prime (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032199000

12

WellCare Elite (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032200000

12

WellCare Dividend Prime (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032201000

16

WellCare Elite (HMO)

Core MAPD w/ Modifications

FST - 16

FL

H1032202000

6

WellCare Reserve (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

FL

H1032203000

10

WellCare Champion (HMO SNP)

Core MAPD w/ Modifications

FST - 10

FL

H1032204000

12

WellCare Dividend Prime (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032205000

12

WellCare Elite (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032206000

6

WellCare Reserve (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

FL

H1032209000

12

WellCare Dividend Prime (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032210000

12

WellCare Dividend Prime (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032211000

12

WellCare Elite (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032212000

12

WellCare Dividend Prime (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032213000

16

WellCare Elite (HMO)

Core MAPD w/ Modifications

FST - 16

FL

H1032214000

6

WellCare Reserve (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

FL

H1032215000

12

WellCare Dividend Prime (HMO)

Core MAPD w/ Modifications

FST - 12

FL

H1032216000

16

WellCare Elite (HMO)

Core MAPD w/ Modifications

FST - 16

FL

H1032217000

6

WellCare Reserve (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

FL

H1032218000

12

WellCare Elite (HMO)

Core MAPD w/ Modifications

FST - 12

GA

H1112006000

6

WellCare Access (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

GA

H1112033000

6

WellCare Liberty (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

GA

H1112035000

11

WellCare Choice (HMO)

Core MAPD w/ Modifications

FST - 11

GA

H1112036001

11

WellCare Value (HMO)

Core MAPD w/ Modifications

FST - 11

GA

H1112036003

11

WellCare Value (HMO)

Core MAPD w/ Modifications

FST - 11

IL

H1416023000

4

WellCare Rx (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 4

IL

H1416024000

4

WellCare Choice (HMO-POS)

Generic Strategy Core MAPD w/ Modifications

FST - 4

MS

H1416026000

6

WellCare Essential (HMO-POS)

Generic Strategy Core MAPD w/ Modifications

FST - 6

TN

H1416031000

6

WellCare Value (HMO-POS)

Generic Strategy Core MAPD w/ Modifications

FST - 6

AR

H1416032000

6

WellCare Value (HMO-POS)

Generic Strategy Core MAPD w/ Modifications

FST - 6

AR

H1416033000

6

WellCare Access (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

MS

H1416034000

6

WellCare Access (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

TN

H1416035000

6

WellCare Access (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

SC

H1416036000

6

WellCare Access (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

MS

H1416038000

6

WellCare Value (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 6

TN

H1416039000

6

WellCare Dividend (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 6

AR

H1416041000

6

WellCare Rx (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 6

TN

H1416042000

6

WellCare Rx (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 6

AR

H1416043000

6

WellCare Liberty (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

MS

H1416044000

6

WellCare Liberty (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

IL

H1416048000

4

WellCare Plus (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 4

SC

H1416052001

11

WellCare Value (HMO)

Core MAPD w/ Modifications

FST - 11

SC

H1416052002

11

WellCare Value (HMO)

Core MAPD w/ Modifications

FST - 11

AR

H1416055000

6

WellCare Preferred (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 6

HI

H2491004000

6

'Ohana Liberty (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

LA

H2491006000

6

WellCare Access (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

LA

H2491007000

6

WellCare Value (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 6

LA

H2491008000

6

WellCare Liberty (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

HI

H2491009000

7

'Ohana Value (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 7

LA

H2491010000

6

WellCare Rx (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 6

NY

H2775082000

17

WellCare Today's Options Advantage Plus 150A (PPO)

Generic Strategy Standard MAPD

FST - 17

NY

H2775099000

17

WellCare Today's Options Advantage Plus 450A (PPO)

Generic Strategy Standard MAPD

FST - 17

NY

H2775102001

17

WellCare Today's Options Advantage Plus 150A (PPO)

Generic Strategy Standard MAPD

FST - 17

ME

H2775102002

17

WellCare Today's Options Advantage Plus 150A (PPO)

Generic Strategy Standard MAPD

FST - 17

NY

H2816013000

4

WellCare Today's Options Premier Plus 250A (PFFS)

Generic Strategy Core MAPD w/ Modifications

FST - 4

TX

H4506003000

10

WellCare TexanPlus Classic (HMO)

Core MAPD w/ Modifications

FST - 10

TX

H4506029000

12

WellCare TexanPlus Choice (HMO-POS)

Core MAPD w/ Modifications

FST - 12

SC

H4847001000

11

WellCare Elite (HMO)

Core MAPD w/ Modifications

FST - 11

SC

H4847002000

11

WellCare Elite (HMO)

Core MAPD w/ Modifications

FST - 11

NY

H4868001000

4

WellCare Today's Options Classic (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 4

NY

H4868002000

6

WellCare Liberty (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

NY

H4868004000

6

WellCare Access (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

NY

H4868005003

6

WellCare Access (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

NY

H4868005004

6

WellCare Access (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

NY

H4868006003

5

WellCare Rx (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 5

NY

H4868006004

5

WellCare Rx (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 5

NY

H4868007000

4

WellCare Choice (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 4

NY

H4868008000

6

WellCare Choice (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 6

NY

H4868009000

4

WellCare Essential (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 4

NY

H4868010000

4

WellCare Preferred (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 4

NY

H4868011001

6

WellCare Value (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 6

NY

H4868011002

6

WellCare Value (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 6

NY

H4868012001

5

WellCare Choice (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 5

NY

H4868012002

5

WellCare Choice (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 5

NY

H4868013000

6

WellCare Value (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 6

CA

H5087001000

8

Easy Choice Freedom Plan (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 8

CA

H5087002000

15

Easy Choice Plus Plan (HMO)

Core MAPD w/ Modifications

FST - 15

CA

H5087005000

13

Easy Choice Best Plan (HMO)

Core MAPD w/ Modifications

FST - 13

CA

H5087016000

13

Easy Choice Best Plan (HMO)

Core MAPD w/ Modifications

FST - 13

CA

H5087017000

15

Easy Choice Plus Plan (HMO)

Core MAPD w/ Modifications

FST - 15

CA

H5087023000

13

Easy Choice Rx (HMO)

Core MAPD w/ Modifications

FST - 13

FL

H5199001000

12

WellCare Premier (PPO)

Core MAPD w/ Modifications

FST - 12

FL

H5199002000

12

WellCare Premier (PPO)

Core MAPD w/ Modifications

FST - 12

FL

H5199003000

12

WellCare Premier (PPO)

Core MAPD w/ Modifications

FST - 12

FL

H5199004000

12

WellCare Premier (PPO)

Core MAPD w/ Modifications

FST - 12

FL

H5199005000

12

WellCare Premier (PPO)

Core MAPD w/ Modifications

FST - 12

FL

H5199006000

12

WellCare Prime (PPO)

Core MAPD w/ Modifications

FST - 12

FL

H5199007000

12

WellCare Premier (PPO)

Core MAPD w/ Modifications

FST - 12

FL

H5199008000

12

WellCare Premier (PPO)

Core MAPD w/ Modifications

FST - 12

FL

H5199009000

12

WellCare Premier (PPO)

Core MAPD w/ Modifications

FST - 12

FL

H5199010000

12

WellCare Prime (PPO)

Core MAPD w/ Modifications

FST - 12

FL

H5199011000

12

WellCare Premier (PPO)

Core MAPD w/ Modifications

FST - 12

FL

H5199012000

12

WellCare Premier (PPO)

Core MAPD w/ Modifications

FST - 12

AZ

H5430001000

6

WellCare Liberty (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

AZ

H6439002000

6

WellCare Value (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 6

AL

H6975001000

6

WellCare Value (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 6

SC

H7326001000

11

WellCare Premier (PPO)

Core MAPD w/ Modifications

FST - 11

SC

H7326002000

11

WellCare Prime (PPO)

Core MAPD w/ Modifications

FST - 11

ME

H9364001000

19

WellCare Value (HMO)

Generic Strategy Standard MAPD

FST - 19

ME

H9364002000

6

WellCare Access (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

KY

H9730002000

4

WellCare Value (HMO)

Generic Strategy Core MAPD w/ Modifications

FST - 4

KY

H9730003000

6

WellCare Access (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

KY

H9730004000

6

WellCare Liberty (HMO SNP)

Generic Strategy Core MAPD w/ Modifications

FST - 6

KY

H9730005000

4

WellCare Essential (HMO-POS)

Generic Strategy Core MAPD w/ Modifications

FST - 4

LA

S4802012000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

TX

S4802013000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

OK

S4802014000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

OR,
WA

S4802020000

1

WellCare Classic (PDP)

Select PDP Super Modified (Classic)

FST - 1

ID,
UT

S4802021000

1

WellCare Classic (PDP)

Select PDP Super Modified (Classic)

FST - 1

VA

S4802069000

1

WellCare Classic (PDP)

Select PDP Super Modified (Classic)

FST - 1

SC

S4802070000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

AL,
TN

S4802071000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

MO

S4802072000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

AR

S4802073000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

MS

S4802074000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

ME,
NH

S4802075000

1

WellCare Classic (PDP)

Select PDP Super Modified (Classic)

FST - 1

CT, MA,
RI,
VT

S4802076000

1

WellCare Classic (PDP)

Select PDP Super Modified (Classic)

FST - 1

NY

S4802077000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

NJ

S4802078000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

DC,
DE,
MD

S4802079000

1

WellCare Classic (PDP)

Select PDP Super Modified (Classic)

FST - 1

PA,
WV

S4802080000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

NC

S4802081000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

GA

S4802082000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

FL

S4802083000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

MI

S4802084000

1

WellCare Classic (PDP)

Select PDP Super Modified (Classic)

FST - 1

OH

S4802085000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

IN,
KY

S4802086000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

IL

S4802087000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

KS

S4802088000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

IA, MN,
MT, ND, NE, SD, WY

S4802089000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

NM

S4802090000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

CO

S4802091000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

AZ

S4802092000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

NV

S4802093000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

CA

S4802094000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

HI

S4802095000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

AK

S4802096000

2

WellCare Classic (PDP)

Select PDP w/ Modifications (Classic)

FST - 2

WI

S4802097000

1

WellCare Classic (PDP)

Select PDP Super Modified (Classic)

FST - 1

ME, NH

S4802098000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

CT, MA, RI, VT

S4802099000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

NY

S4802100000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

NJ

S4802101000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

DC, DE, MD

S4802102000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

PA, WV

S4802103000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

VA

S4802104000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

NC

S4802105000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

SC

S4802106000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

GA

S4802107000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

FL

S4802108000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

AL, TN

S4802109000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

MI

S4802110000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

OH

S4802111000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

IN, KY

S4802112000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

IL

S4802113000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

MO

S4802114000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

AR

S4802115000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

MS

S4802116000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

TX

S4802118000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

OK

S4802119000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

KS

S4802120000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

IA, MN, MT, ND, NE, SD, WY

S4802121000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

NM

S4802122000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

CO

S4802123000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

NV

S4802125000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

ID, UT

S4802127000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

CA

S4802128000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

HI

S4802129000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

AK

S4802130000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

WI

S4802132000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

LA

S4802133000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

AZ

S4802134000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

OR, WA

S4802135000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

ME, NH

S4802136000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

CT, MA, RI, VT

S4802137000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

NY

S4802138000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

NJ

S4802139000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

DC, DE, MD

S4802140000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

PA, WV

S4802141000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

VA

S4802142000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

NC

S4802143000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

SC

S4802144000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

GA

S4802145000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

FL

S4802146000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

AL, TN

S4802147000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

MI

S4802148000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

OH

S4802149000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

IN, KY

S4802150000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

IL

S4802151000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

MO

S4802152000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

AR

S4802153000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

MS

S4802154000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

TX

S4802155000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

OK

S4802156000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

KS

S4802157000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

IA, MN, MT, ND, NE, SD, WY

S4802158000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

NM

S4802159000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

CO

S4802160000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

NV

S4802161000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

ID, UT

S4802162000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

CA

S4802163000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

HI

S4802164000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

AK

S4802165000

3

WellCare Value Script (PDP)

Generic Strategy Core PDP Super Modified (Value Script)

FST - 3

WI

S4802166000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

LA

S4802167000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

AZ

S4802168000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

OR, WA

S4802169000

3

WellCare Extra (PDP)

Generic Strategy Core PDP Super Modified (Extra)

FST - 3

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Last Updated On: 2/17/2017