What pharmacies are in the wellcare network

Beginning in January 2023, Wellcare will expand its range of Medicare Advantage (MA) and Medicare Prescription Drug Plan (PDP) offerings. Wellcare serves almost 1.5 million Medicare Advantage plans across 36 states. In 2023, Wellcare will offer 48 redesigned plans.

Its pharmacy offerings will be expanded to include 102 plans nationwide and will include $0 copays for COVID-19 vaccines and testing. Additionally, Amazon is now a preferred retail pharmacy.

All plans will include a $0 tier 1 benefit when filled at preferred pharmacies, including Amazon, Walgreens, CVS, and most grocers. Part D Senior Savings Model (SSM), which reduces member spending on insulin, will be offered on Value Script and Value Plus products. A new formulary design will be offered on the Value Script and Value Plus plans; it will contain medications commonly used to treat diabetes and will cost only $11 per 30-day supply.

“As Medicare Advantage enrollment continues to grow across the country, Wellcare is proud to offer more plans, enhanced benefits, and greater choices to help our members and those eligible for Medicare live better, healthier lives,” Rich Fisher, chief executive officer of Medicare for Centene, Wellcare’s parent company, said in a press release.

The Medicare Advantage plans will expand Preferred Provider Organization (PPO) offerings. It will also offer “giveback” plans that reduce some or all of the Part B premium available and provide low-income subsidy plans to those who qualify. Wellcare Patriot plans are also available for Veteran members.

Please reference your personal Rx Report by provided by HTA which shows the plan premium, copays by tier ranking, specific costs and and drug limits or restrictions for your current medication list.

Pharmacies

• Preferred Pharmacy Search: WellCare has preferred pharmacies where you can get lower co-pays such as CVS.
• Mail Order Vendor: Caremark www.caremark.com or 1-866-808-7471
  • You should receive more details on how to sign up for mail order in your policy.  You cannot set this up until your policy is active.

Plan Documents

• Summary of Benefits- click on your resident state below
• Formulary Rx List
• Carrier Star Ratings

All Medicare Prescription Drug Plans have 4 Stages of Coverage.

Please click on the link for more details and a short video overview on Medicare Prescription Drug Plans and Stages.

You have a wide variety of primary care physicians, specialists, hospitals and outpatient facilities to choose from. Use our Find a Provider tool to search for in-network doctors or pharmacies anywhere in the U.S. 

Select your home state

WellCare Health Plans, Inc., (PDP) is a Medicare-approved Part D sponsor. Enrollment in our plans depends on contract renewal. Our plans use a formulary. The formulary and/or pharmacy network may change at any time. You will receive notice when necessary. WellCare Prescription Drug Plan, Inc.’s, pharmacy network includes limited lower-cost, preferred pharmacies in rural areas of AR, KS, OK ; and urban areas of MO, MS. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 833-207-4241 (TTY 711) for Rx Saver, Rx Select and Rx Value Plus plans; and 888-550-5252 (TTY 711) for Classic, Value Script and Wellness Rx plans or consult the online pharmacy directory at www.wellcare.com/PDPopens a simulated dialog .

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Wellcare is the Medicare brand for Centene Corporation, an HMO, PPO, PFFS, PDP plan with a Medicare contract and is an approved Part D Sponsor. Our D-SNP plans have a contract with the state Medicaid program. Enrollment in our plans depends on contract renewal. “Wellcare” is issued by Prescription Insurance, Inc.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE TTY users can call 1-877-486-2048, 24 hours a day, 7 days a week to get information on all of your options.

1 $0 copay on Tier 1 generic drugs when enrolled in plans where Walgreens is a Preferred Pharmacy.

2† Other Pharmacies/Physicians/Providers are available in our network. Please contact your plan for details.

3 Advice is free with no obligation to enroll and provided by independent licensed agents representing one or more plans. Licensed agents are not employees or agents of Walgreens, eHealth or any government agency.

WellCare of North Carolina is committed to working with providers to improve members' health and well-being. The following information will help your patients get the most out of their pharmacy benefits.

Coverage Determination Request

The coverage determination process enables providers to request an addition or exception.

• Electronic Prior Authorization (ePA): Cover My Meds
• Online: Request Prescription Drug Coverage
• Fax or Mail: Complete a request for prescription drug coverage (PDF)

Medication Appeals

Providers may appeal a coverage determination decision by contacting our Pharmacy Appeals department via fax, mail, in person or phone. Please refer to the Quick Reference Guide for instructions.

• Online: Request Appeal for Drug Coverage
• Fax or Mail: Complete an appeal of coverage determination request (PDF)

Preferred Drug List (PDL)

The Preferred Drug List contains information about drugs covered by the plan. Please check back for updates, as PDLs are periodically amended.

• Search for a Drug

The NC Medicaid Preferred Drug List (PDL) allows NC Medicaid to obtain better prices for covered outpatient drugs through supplemental rebates. The PDL was authorized by the NC General Assembly Session Law 2009-451, Sections 10.66(a)-(d).

• Prescribers are encouraged to write prescriptions for “preferred” products.
• Prescribers may continue to write prescriptions for drugs not on the PDL.
• If a prescriber deems that the patient’s clinical status necessitates therapy with a non-preferred drug, the prescriber will be responsible for initiating a prior authorization request.
• Prior authorization requirements may be added to additional drugs in the future.
• Submit Proposed Clinical Policy Changes to the PDL
• Preferred Drug List Review Panel

Printed Preferred Drug Lists

• North Carolina Preferred Drug List

Outpatient Pharmacy Services

• Outpatient Pharmacy Policies (9, 9A, 9B, 9D and 9E)

Additional Information

AcariaHealth Specialty Pharmacy 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 AcariaHealth Specialty Pharmacy page.