List of Drugs (Formulary) |

List of Drugs (Formulary)


Our list of drugs (formulary) shows the Part D drugs that we cover. In general, we cover your drugs if they are medically necessary. Drugs on our list of drugs are covered when you use our network pharmacies or preferred mail order service for maintenance drugs. Maintenance drugs are drugs you take for a chronic or long-term condition. Some drugs we cover have limits or other rules.

The Pharmacy and Therapeutics Committee, our team of independent healthcare experts, reviews and approves our list of drugs. We don’t include all drugs. Some drugs may not be covered or are excluded. Other drugs are not on the list because of clinical and cost reasons.

How Do I Search for a Drug in the List of Drugs (Formulary)?

You can search for a drug by using our Drug Search Tool or by opening the List of Drugs (Formulary) PDF document. Each option gives you a complete list of covered drugs and any restrictions or limits. The search tool also shows you covered drug alternatives. 

The PDF document lists drugs by medical condition and alphabetically within the index. To search for your drug in the PDF, hold down the “Control” (Ctrl) and “F” keys. When the search box appears, type the name of your drug. Press the “Enter” key. You also have the option to print the drug list as a PDF document. The drug list is updated monthly.

          Updated March 1, 2024:

List of Drugs Change Notice

Drugs may be added or removed from our list of drugs during the year. Generally, we will tell you before we make one of the following changes to the list of drugs:

  • Remove a drug from the list.
  • Change drug requirements.
  • Move a drug to a higher cost sharing tier.

If the Food and Drug Administration (FDA) or the drug’s maker says a drug is not safe, it will be removed from our list of drugs right away. In addition, if a new generic drug comes to market, we may remove the brand name drug. To view the changes, open the List of Drug Change Notice PDF document below.

List of Drugs Change Notice: February 1, 2024
 

  • Wellcare No Premium Open (PPO)

 

  • Wellcare No Premium (HMO)
  • Wellcare No Premium Focus (HMO)
    • Imperial, San Diego, San Francisco
  • Wellcare No Premium Ruby (HMO)
  • Wellcare Premium Ultra (HMO)

 

  • Wellcare Dual Liberty (HMO D-SNP)
  • Wellcare Specialty No Premium (HMO C-SNP)

 

  • Wellcare Low Premium (HMO)
  • Wellcare No Premium Focus (HMO)
    • Los Angeles, Orange, Riverside, San Bernardino

 

  • Wellcare CalViva Health Dual Align (HMO D-SNP)
  • Wellcare Dual Align (HMO D-SNP)

Drug Coverage Determinations

You can ask us to make an exception to our coverage rules for your drug(s). To learn about the types of exceptions, refer to your Evidence of Coverage or Member Handbook. When asking for an exception, include a statement from your doctor that supports your request, plus a completed Coverage Determination form.

Generally, we must decide on your request within 72 hours after we get your doctor’s statement. You or your doctor can request a fast (expedited) exception if your health may be harmed by waiting. If we approve your expedited request, we must give you a decision within 24 hours after we get your doctor’s supporting statement.

Generic Drugs

We cover both brand name drugs and generic drugs. Generic drugs have the same active ingredient formula as a brand name drug.  

Generic drugs are are FDA-approved and are as safe and effective as brand name drugs. They have the same active ingredients, indications, dosages, safety, and strengths as the brand name drugs and generally cost less. Ask your doctor if any of your drugs are available as a generic, and if a generic version will work for you. 

Mail Order Service

You can fill your prescription at any network pharmacy. You also can fill your prescription through our preferred mail order service—Express Scripts® Pharmacy. You can find more information about receiving your prescriptions through mail service delivery on our Mail Order Service page.

If you have questions about our list of drugs, or want the most recent version, contact Member Services. We are here to help.