Formularies
2025
2025 Comprehensive Formulary | Wellcare Fidelis Dual Access (Plan 001)
2025 Comprehensive Formulary | Wellcare Fidelis Assist (Plan 002)
2025 Comprehensive Formulary | Wellcare Fidelis Dual Plus (Plan 003)
2025 Comprehensive Formulary | Wellcare Fidelis Simple (Plan 004)
Additional Documents
2025 Covered Diabetes Meters and Testing Supplies2025 Formulary Transition Policy
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 SubstitutionIf 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.