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 WellCare's 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
Request a coverage decision and/or exception or file an appeal of a drug coverage decision.
Clinical Pharmacy Policies
- AbobotulinumtoxinA (Dysport) CP-230 (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)
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 of up to $10 per household for personal care products delivered right to their home. Examples include items such as vitamins and cough medicine.