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Medicare Advantage and Dual Advantage
A drug formulary is a list of both generic and brand name prescription drugs that are covered by your prescription drug benefit. The formulary is actively managed and updated through Wellcare By Fidelis Care's Pharmacy and Therapeutics Committee, qualified pharmacists and doctors whose primary focus is offering safe, high-quality and cost-effective drugs. New drugs are added to the formulary periodically based on the latest medical research and some drugs may be removed periodically based on the findings and recommendations of the Pharmacy and Therapeutics Committee.
You may be able to spend less each month on your prescription drugs. Here are three ways to save:
Click below for formulary, prior authorization, step therapy criteria, mail order enrollment, and other Medicare Part D prescription drug benefits provided by Wellcare By Fidelis Care's Medicare and Dual Advantage plans.
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)
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)
2027 PA Criteria | Wellcare Fidelis Assist (Plan 002)
2027 PA Criteria | Wellcare Fidelis Dual Align Unity (Plan 003)
2027 PA Criteria | Wellcare Fidelis Simple (Plan 004)
2027 PA Criteria | Wellcare Fidelis Dual Liberty Sync (Plan 014)
2027 PA Criteria | Wellcare Fidelis Dual Liberty Sync (Plan 015)
2027 PA Criteria | Wellcare Fidelis Dual Access (Plan 016)
2027 PA Criteria | Wellcare Fidelis Dual Access (Plan 017)
2026 PA Criteria | Wellcare Fidelis Assist (Plan 002)
2026 PA Criteria | Wellcare Fidelis Dual Align (Plan 003)
2026 PA Criteria | Wellcare Fidelis Simple (Plan 004)
2026 PA Criteria | Wellcare Fidelis Dual Liberty Sync (Plan 013-001)
2026 PA Criteria | Wellcare Fidelis Dual Liberty Sync (Plan 013-002)
To learn more about Prior Authorization, Step Therapy, Quantity Limits, and other prescription drug coverage requirements, click here .
Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. If your drug needs this step, you or your doctor will need to ask for and get advance approval from Wellcare By Fidelis Care to cover the drug.
2027 ST Criteria | Wellcare Fidelis Assist (Plan 002)
2027 ST Criteria | Wellcare Fidelis Dual Align Unity (Plan 003)
2027 ST Criteria | Wellcare Fidelis Simple (Plan 004)
2027 ST Criteria | Wellcare Fidelis Dual Liberty Sync (Plan 014)
2027 ST Criteria | Wellcare Fidelis Dual Liberty Sync (Plan 015)
2027 ST Criteria | Wellcare Fidelis Dual Access (Plan 016)
2027 ST Criteria | Wellcare Fidelis Dual Access (Plan 017)
2026 ST Criteria | Wellcare Fidelis Assist (Plan 002)
2026 ST Criteria | Wellcare Fidelis Dual Align (Plan 003)
2026 ST Criteria | Wellcare Fidelis Simple (Plan 004)
2026 ST Criteria | Wellcare Fidelis Dual Liberty Sync (Plan 013-001)
2026 ST Criteria | Wellcare Fidelis Dual Liberty Sync (Plan 013-002)
To learn more about Step Therapy, Quantity Limits, and other prescription drug coverage requirements, click here .
Step Therapy is a process whereby prescriptions are filled using an effective and more affordable medication (Step 1). When appropriate, a more costly (Step 2) medication can be authorized if the Step 1 prescription is found to not be effective in treating your medical condition.
Fidelis Care has contacts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area. There are over 4,400 pharmacies located in New York State that participate in our pharmacy network and over 64,400 network pharmacies nationwide.
2027
2026
Learn about participating specialty pharmacies and the support available for medications used to treat long-term, complex, or rare chronic conditions.
View Specialty Pharmacy
The purpose of this form is to request coverage of a medication that is not on your plan’s drug list or restricted in some way.
You can submit this form in two ways:
- Option 1. (Recommended) complete the online form by following the link below.
- Option 2. Download the PDF hard copy and send to the address at the bottom of this document.
1. Online Form: Medication Request Form
2. Paper Form: Medication Request Form
Wellcare By Fidelis Care Attn: Medicare Pharmacy Appeals P.O. Box 31383 Tampa, FL 33631-3383
Members may ask us for an appeal through our website at www.fideliscare.org. Expedited appeal requests can be made by phone at 1-800-247-1447. Your prescribing doctor may ask us for an appeal on your behalf. If you want another individual (such as a family member or friend) to request an appeal for you, that individual must be your representative.
For additional information, visit our Coverage Determinations and Redeterminations for Drugs support page.
You can have your medications delivered directly to your home, so you don’t have to make unnecessary trips to the local pharmacy. Not only does this service save you time, it also saves you money. You may be eligible to get up to a 100-day supply of your medication for the price you would pay for two 30-day supplies picked up at the pharmacy counter.
For your convenience, Wellcare By Fidelis Care offers direct mail options to fill your durable medical equipment needs. These providers offer a wide range of supplies such as diabetes test strips, bladder control pads, bandages, and more.
Clicking the links above will cause you to leave the Fidelis Care website
Please use this Prescription Drug Claim Form when you paid for a Medicare Part D covered prescription drug and are asking us to pay you back. Check your Evidence of Coverage (EOC) on our Medicare Resources page for more details on completing this form.
If you would like another person to complete the Prescription Drug Claim Form on your behalf, please check the appropriate box on the claim form and return a signed Appointment of Representative (AOR) Form (CMS-1696) along with your completed claim form. The AOR form is available below:
Click HERE to request coverage for a medication that is not on your plan’s drug list or restricted in some way. Completion of this form provides information for the plan to decide whether to waive the restriction for you. *Approval is not guaranteed.
Wellcare By Fidelis Care is committed to making sure you have access to affordable medication and convenient options for filling prescriptions. Log in to your Member Portal account for quick access to your pharmacy benefit. (If you don't already have an account, it's easy to create an account.)
Did you get Extra Help - Low Income Subsidy Assistance - paying for your prescription drug costs in 2027? To get assistance again this year, you must apply for recertification. View or download our Prescription Drug Extra Help Checklist to ease your qualification process.
Most Wellcare By Fidelis Care plans offer members a prepaid account to use to purchase non-prescription, over-the-counter drugs and many common health-related items at local pharmacies. Your OTC benefit will be part of your Wellcare Spendables card.
Explore additional resources to help you understand your Medicare prescription drug coverage, find participating pharmacies, manage medications, and learn about coverage requirements.
Wellcare is the Medicare brand for Centene Corporation, an HMO, PPO, 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.
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H5599_12364_M_2027
Last Updated 10.5.2026