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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

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.

Over-the-Counter Benefits (PDF)