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Wellcare Giveback (HMO)

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Drug List

Have questions about which medications are covered by your plan? Access your formularies here or search a drug via the search tool.

Drug Search Tool

Search a Drug via the Search Tool

Drug List and Other Documents

Comprehensive Formulary

Notice of Change

Prior Authorization

Step Therapy

Pharmacy Forms

Complete this form to request reimbursement for covered prescription drugs that you paid full price for.

Members can complete this form to order prescriptions from Express Scripts® Pharmacy.

Preferred diabetes testing supplies list (blood glucose meters and test strips) you can receive from an in-network pharmacy for plan years 2024 and 2025.

This document outlines your rights with regards to your Medicare drug plan.

Complete this printable form to ask us for a decision about a prescription drug and your specific plan coverage. Members should fax form to 1-866-388-1767.

Complete this printable form to ask for an appeal after being denied a request for coverage or payment for a prescription drug. Members should fax form to 1-866-388-1766.

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Y0020_WCM_134133E_M Last Updated On: 8/15/2023
On Feb. 21, 2024, Change Healthcare experienced a cyber security incident. Any individuals impacted by this incident will receive a letter in the mail. Learn more about this from Change Healthcare, or reach out to the contact center at 1-866-262-5342. ×