Medicare List of Drugs and Formulary Information
Our List of Drugs, also called a formulary, shows the prescription drugs covered by Wellcare By Fidelis Care. This page includes tools and documents to help you search for covered drugs, review coverage requirements, and understand changes to your drug coverage.
About the List of Drugs
In general, we cover your prescription drugs when they are medically necessary and filled through a network pharmacy or our preferred mail order service. Mail order service may be available for maintenance drugs, which are drugs you take regularly for a chronic or long-term condition.
Our List of Drugs does not include every prescription drug. Some covered drugs have limits, restrictions, or other coverage requirements. Other drugs may be excluded from coverage or may not be included because of clinical or cost considerations.
How to Search for a Covered Drug
You can search for a drug by using our Drug Search Tool or by opening the List of Drugs PDF document for your plan. Each option provides a complete list of covered drugs and shows applicable restrictions or limits. The Drug Search Tool can also show covered alternatives.
The PDF document lists drugs by medical condition and alphabetically within the index. To search for your drug in the PDF, hold down the Control (Ctrl) and F keys. When the search box appears, type the name of your drug. Press the Enter key. You also have the option to print the drug list as a PDF document. The drug list is updated monthly.
For additional support on searching for a drug and understanding your results, visit our List of Drugs Search Tool support page.
List of Drugs Search Tools and Documents
List of Drugs Search Tool
Use the online Drug Search Tool to search for covered medications, coverage tiers, restrictions, dosage information, and covered formulary alternatives.
To view the formulary search tool for your specific Wellcare By Fidelis Care plan, visit our Prescription Drug Information page and select the Prescription Drug Formularies accordion.
List of Drugs Documents
To view the List of Drugs, also called a formulary, for your specific Wellcare By Fidelis Care plan, visit our Medicare Resources page and select the accordion that matches your plan name.
List of Drugs Change Notices
Our List of Drugs can change during the year. Most drug coverage changes take effect at the beginning of the year. However, we may make certain changes during the year.
Generally, we will notify you before making any of the following midyear changes:
- Adding or removing a drug from the List of Drugs.
- Moving a drug to a higher or lower cost-sharing tier.
- Adding or removing a coverage restriction for a drug.
- Replacing a brand-name drug with a generic version of the drug.
- Replacing an original biological product with an interchangeable biosimilar version of the biological product.
If the U.S. Food and Drug Administration (FDA) or a drug manufacturer determines that a drug is unsafe or removes it from the market for another reason, we will remove it from our List of Drugs immediately. We may also remove a brand-name drug when a new generic version becomes available.
To view the List of Drugs Change Notice for your specific Wellcare By Fidelis Care plan, visit our Medicare Resources page and select the accordion that matches your plan name.
For more information about midyear changes to the List of Drugs, refer to your Evidence of Coverage on our Medicare Resources page.
Alternative Drug List
Are you currently taking a drug that is not covered on your plan’s List of Drugs (formulary)?
The form below is a list of some common drugs that are not covered, along with their covered
alternative drugs. Talk to your provider to see if the drug alternatives listed in the PDF
form below will work for you.
Alternative Drug List - English (PDF)
Alternative Drug List - Spanish (PDF)
Drug Coverage Determinations
You can ask us to make an exception to our prescription drug coverage rules. For example, you may ask us to cover a drug that is not on the List of Drugs or remove a coverage restriction that applies to your drug.
To learn about the types of exceptions you may request, refer to your Evidence of Coverage on our Medicare Resources page.
When requesting an exception, include a statement from your doctor explaining why the drug is medically necessary, along with a completed Drug Coverage Determination Request Form .
Generally, we must make a decision within 72 hours after we receive your doctor’s supporting statement. You or your doctor may request a fast, or expedited, exception if waiting for a standard decision could harm your health.
If we approve your request for an expedited decision, we must provide a decision within 24 hours after we receive your doctor’s supporting statement.
For more information about requesting an exception or appealing a drug coverage decision, visit our Coverage Determinations and Redeterminations for Drugs page.
Generic Drugs
We cover both brand-name and generic drugs. Generic drugs contain the same active ingredients as their brand-name versions and are approved by the FDA. They have the same indications, dosages, safety standards, strengths, and intended effects as brand-name drugs and generally cost less.
Ask your doctor whether any of your medications are available as a generic and whether the generic version may be appropriate for you.
Mail Order Service
You can fill your prescription at any network pharmacy. You may also fill eligible prescriptions through our preferred mail order service, Express Scripts® Pharmacy. Mail order service may help save you time, money, and trips to the pharmacy.
Learn more about receiving your prescriptions through mail delivery on our Mail Order Service page.
Additional Drug Coverage Information
For information about prior authorization, step therapy, quantity limits, and other coverage requirements, visit our Prior Authorization, Step Therapy and Quantity Limits page.
If a drug you take is not covered or has new restrictions, visit our Drug Transition Policy page to learn whether you may qualify for a temporary supply.
To find an in-network pharmacy or learn about specialty pharmacies, out-of-network coverage, pharmacy directories, and prescription reimbursement, visit our Pharmacy Networks page.
If you have questions, call Member Services at 1-800-247-1447 (TTY: 711). We are here to help.