Formularies
2027
2027 Comprehensive Formulary | Wellcare Fidelis Assist (Plan 002)
2027 Comprehensive Formulary | Wellcare Fidelis Dual Align Unity (Plan 003)
2027 Comprehensive Formulary | Wellcare Fidelis Simple (Plan 004)
2027 Comprehensive Formulary | Wellcare Fidelis Dual Liberty Sync (Plan 014)
2027 Comprehensive Formulary | Wellcare Fidelis Dual Liberty Sync (Plan 015)
2027 Comprehensive Formulary | Wellcare Fidelis Dual Access (Plan 016)
2027 Comprehensive Formulary | Wellcare Fidelis Dual Access (Plan 017)
Additional Documents
2026
2026 Comprehensive Formulary | Wellcare Fidelis Assist (Plan 002)
2026 Comprehensive Formulary | Wellcare Fidelis Dual Align (Plan 003)
2026 Comprehensive Formulary | Wellcare Fidelis Simple (Plan 004)
2026 Comprehensive Formulary | Wellcare Fidelis Dual Liberty Sync (Plan 013-001)
2026 Comprehensive Formulary | Wellcare Fidelis Dual Liberty Sync (Plan 013-002)
Additional Documents
Formulary Exceptions
If a drug is not covered in the way you would like it to be covered,
you can ask us to make an “exception.” An exception is a type of coverage
decision. Similar to other types of coverage decisions, if we turn down
your request for an exception, you can appeal our decision. Asking for
coverage of a drug that is not on the Prescription Drug Formulary, also
called the Drug List, is sometimes called asking for a
“formulary exception.”
When you ask for an exception, your doctor or other prescriber will
need to explain the medical reasons why you need the exception approved.
The information can be submitted by phone, fax, mail or electronically.
We will then consider your request.
Drug Tiers
The price of a drug is determined by what “tier” it is on within your
formulary. A generic drug may appear on a “preferred tier,” while a
brand-name drug may appear on a “non-preferred tier.” Medicine listed
on a non-preferred tier may be more expensive than those on a preferred
tier. You can reduce how much you pay for prescription drugs by using
preferred tier drug. You should talk to your primary care physician
about preferred tier options available to you.
Generic Substitution
If Wellcare By Fidelis Care receives a prior authorization or
exception request, the medication requested will be generically
substituted when an authorized, AB rated equivalent generic is available,
unless the request specifically indicates that the brand name is being
requested (e.g. Dispense as Written, brand only, etc.), rejections in
prescription claims history are for brand, or supporting documentation
indicates brand is being prescribed or why generic is not an appropriate
treatment option.
Formulary Transition Policy
When you have a drug that is not on our formulary, or if your ability
to get the drug is limited, we will cover a temporary supply of the drug
until you can switch to a drug we cover or you can request a formulary
exception.
Using the Drug Search Tool
Need help searching for a covered medication? Visit our
List of Drugs Search Tool
support page for step-by-step instructions on searching by drug name,
class, or alphabetically, and to learn how to interpret your search
results, including coverage tiers, restrictions, dosage information,
and formulary alternatives.