What is Covered by Medicare Part D Drug Programs?

All NYS plans are required to cover a wide array of prescription medications that Medicare beneficiaries use, including those in a number of "protected classes."  For example, those used to treat HIV/AIDS and cancer. 

Every plan has its own formulary, which is a list of the medications that are covered by the plan. Numerous plans categorize their formularies of medications into various "tiers" or levels. Each tier of drugs has a distinct price. For instance, you will often pay less for a medicine in a lower tier than one in a higher tier.

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Drug Tier Co-Payment/Coinsurance Amounts (2023)

For all Wellcare By Fidelis Care plans, prescription drugs are grouped into one of five tiers. To find out which tier your drug is in, look in the Drug Tier column of the formulary that begins on page 1. For more detailed information about your out-of-pocket costs for prescriptions, including any deductible that may apply, please refer to your Evidence of Coverage and other plan materials.


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  • Tier 1 (Preferred Generic Drugs) includes preferred generic drugs and may include some brand drugs.
    • Preferred copayment: $0
    • Standard copayment: $8

  • Tier 2 (Generic Drugs) includes generic drugs and may include some brand drugs.
    • Preferred copayment: $4
    • Standard copayment: $15

  • Tier 3 (Preferred Brand Drugs) includes preferred brand drugs and may include some generic drugs.
    • Preferred copayment: $42
    • Standard copayment: $47
    • Preferred select insulins copayment: $35
    • Standard select insulins copayment: $35

  • Tier 4 (Non-Preferred Drugs) includes non-preferred brand and non-preferred generic drugs.
    • Preferred coinsurance: 47%
    • Standard coinsurance: 50%

  • Tier 5 (Specialty Tier) includes high cost brand and generic drugs. Drugs in this tier are not eligible for exceptions for payment at a lower tier.
    • Preferred coinsurance: 25%
    • Standard coinsurance: 25%

 

 

  • Our Medicare Advantage Plans are designed to help our members live better, healthier lives. You’re our critical partner in helping our future members understand all we have to offer and how they can take advantage of all of their benefits.
  • The Healthy Food Program engages food-insecure members by encouraging healthy food purchases in-store and online, with no prior authorization or referral needed. Members will automatically receive a prepaid card used to buy healthy foods at certain retailers and the available funds ($25 or $50, varying by plan) will replenish each month. (Note: Any unused funds will not carry over into the next month).
  • Healthy Foods Benefits and $0 Rx copays are just one way our Medicare Advantage plans and supplemental benefits support our member’s whole health. More plan and benefit information is available in your other sales materials, including the Portfolios At A Glance and the Benefit Highlights.  You can also explore our other supplemental benefit videos to learn more about how Wellcare goes beyond healthcare benefits to help our members live fuller lives.

 

 

OTC Benefit

Use your OTC account to purchase
over-the-counter (OTC) eligible items
that help treat injuries or illness. 

$0 Rx Copays and Food Card

New savings to help our 
Dual Eligible Special Needs Plan
members stay healthy

Telehealth

Receive online care from NY State-licensed doctors, 24 hours a day, 7 days a week.

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Additional Information

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.

From October 1 to March 31, you can call us 7 days a week from 8 a.m. to 8 p.m. From April 1 to September 30, you can call us Monday through Friday from 8 a.m. to 8 p.m. A messaging system is used after hours, weekends and on federal holidays.

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Last Updated 10.1.2022