2023 Comprehensive Formulary | Wellcare Fidelis Assist (Plan 002)
2023 Comprehensive Formulary | Wellcare Fidelis No Premium (Plan 004)
2023 Comprehensive Formulary | Wellcare Fidelis Dual Access & Dual Plus (Plans 001, 003, 008)
Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible*. Call Member Services for more information.
Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible*.
Additional Documents 2023 Formulary Transition Policy 2023 Medicare Member Health Guide 2023 Covered Diabetes Meters and Testing Supplies
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.
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.
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.