The WellCare Pharmacy Services team is committed to quality service and partnership with our providers to improve our members’ health and well-being. To help your patients get the most out of their pharmacy benefit.
Preferred Drug List (PDL)
The PDL is a clinical guide of prescription drug products selected by the Department for Medicaid Services' Pharmaceutical and Therapeutics (P&T) Committee based on a drug's efficacy, safety, side effects, pharmacokinetics, clinical literature and cost-effectiveness.
Pharmacy Utilization Management Tools
Our pharmaceutical management procedures are integral in ensuring and promoting the utilization of the most clinically appropriate agent(s) to improve the health and well-being of our members.
Coverage Determination Requests
For Pharmacy Prior Authorization requests call 1-844-336-2676 or fax all pharmacy PA requests to 1-858-357-2612 beginning July 1, 2021. You may also submit your request online through Cover My Meds, Surescripts, or CenterX ePA portals.
To Appeal Initial Drug Denial with Date of Service on or after 7/1 submit to MedImpact.
Contact MedImpact Prior Authorization call Center Number at 1-844-336-2676 (8am-7pm EST)
Appeals can also be mailed to:
Appeals and Grievances Department
MedImpact Healthcare Systems, Inc.
10181 Scripps Gateway Court
San Diego, CA 92131
or fax to the appeals team at (858) 790-6060.
Clinical Pharmacy Policies
- AbobotulinumtoxinA (Dysport) CP-230 (PDF)
- Aducanumab-avwa (Aduhelm) CP-468 (PDF)
- IncobotulinumtoxinA (Xeomin) CP-231 (PDF)
- OnabotulinumtoxinA (Botox) CP-232 (PDF)
- RimabotulinumtoxinB (Myobloc) CP-233 (PDF)
- Eteplirsen (Exondys 51) CP-288 (PDF)
- Ocrelizumab (Ocrevus) CP-335 (PDF)
- Edaravone (Radicava) CP-343 (PDF)
- Testosterone (Testopel, Jatenzo) CP-354 (PDF)
- Tisagenlecleucel (Kymriah) CP-361 (PDF)
- Axicabtagene Ciloleucel (Yescarta) CP-362 (PDF)
- Voretigene Neparvovec-rzyl (Luxturna) CP-372 (PDF)
- Ibalizumab-uiyk (Trogarzo) CP-378 (PDF)
- Caplacizumab-yhdp (Cablivi) CP-416 (PDF)
- Spinal Muscular Atrophy (Evrysdi, Zolgensma) Update (PDF)
Other Helpful Information
The WellCare Specialty Pharmacy offers expert service in the special handling, storage and administration of medications for members who have long-term, life-threatening or rare conditions. With its knowledge of the insurance process and plan benefits, the team can speedily help the patient receive his or her medication. For a detailed list of conditions covered, please visit our Exactus Specialty Pharmacy page.
WellCare's medical injectables' prior authorization requirements are aligned with current industry practice. Most self-injectable and infusion medications require prior authorization. Use our authorization look-up tool to search quickly and easily by CPT code.
We encourage providers to alert members they can receive a monthly credit for personal care products delivered right to their home. Examples include items such as vitamins and cough medicine. Households can recieve the following based on household:
- 1 person household - $10 per month
- 2 person household - $20 per month
- 3+ person household - $25 per month