Pharmacy Networks
Wellcare By Fidelis Care members have access to a variety of pharmacy resources and services. Explore the information below to learn about in-network and out-of-network pharmacies, specialty pharmacies, mail order service, prescription reimbursement and more.
Pharmacy Resources
In-Network Pharmacies
You can fill your prescriptions at any pharmacy in our nationwide network. This includes many major retail chains and independent pharmacies. Our network also includes mail order pharmacies, long-term care pharmacies, home infusion services and Indian Health Service, Tribal and Urban Indian Health programs.
To fill a prescription, ask your prescriber to send it to the network pharmacy of your choice. When you arrive at the pharmacy, present your Member ID card. If your card is not available, you can access your ID card online through the Member Portal.
Find a network pharmacy near you by using the Find a Provider or Pharmacy search tool. You can also download or print a copy of the Pharmacy Directory.
If you need help, call Member Services at 1-888-343-3547 (TTY: 711).
For more information about filling your prescriptions at network pharmacies, refer to your Evidence of Coverage on our Medicare Resources page or call Member Services at 1-888-343-3547 (TTY: 711).
Specialty Pharmacy
Our specialty pharmacies are available at no extra cost to members taking drugs used to treat long-term, complex or rare chronic conditions, such as cancer, rheumatoid arthritis, HIV or hemophilia.
Specialty pharmacies can help you manage side effects and symptoms, take your medications on time and as prescribed, and request refills.
Other in-network specialty pharmacies may be available depending on your plan. Find a network pharmacy near you by using our Find a Provider or Pharmacy search tool. You can also download or print a copy of the Pharmacy Directory.
If you need help, call Member Services at 1-888-343-3547 (TTY: 711).
Not all specialty pharmacies carry every drug. Available medications depend on the drug and your plan. Before you transfer or fill a prescription, call the specialty pharmacy you choose to confirm that it can fill your prescription.
For more information about specialty pharmacies, refer to your Evidence of Coverage on our Medicare Resources page or call Member Services at 1-888-343-3547 (TTY: 711).
Out-of-Network Pharmacies
We have thousands of pharmacies in our nationwide network to make it easier to get your prescription drugs. Using a network pharmacy is usually the best option for lowering costs and reducing paperwork.
However, there may be times when you cannot use a network pharmacy. We may cover a prescription filled at an out-of-network pharmacy if:
- There is not a network pharmacy nearby that is open.
- You need a drug that you cannot get at a network pharmacy close to you.
- You need a drug for emergency or urgent medical care.
- You must leave your home because of a federal disaster or another public health emergency.
Always call Member Services first at 1-888-343-3547 (TTY: 711) or use the Find a Provider or Pharmacy tool to check whether there is a network pharmacy near you.
Traveling or Away from Home
If you take a prescription drug regularly and are planning to travel, check your supply before you leave. When possible, bring all the medications you will need for your trip.
If you travel within the United States and its territories, we may cover your drug at an out-of-network pharmacy for the reasons listed above. However, we cannot pay for prescriptions filled outside the United States and its territories, including prescriptions filled while traveling on a cruise, even during a medical emergency.
If you use an out-of-network pharmacy, you may need to pay the full cost of your prescription at the time of purchase. You can then ask us to reimburse you for our share of the cost. Reimbursement is not guaranteed.
Out-of-network and non-contracted providers are under no obligation to treat plan members, except in emergency situations. For more information, including the cost-sharing that applies to out-of-network services, refer to your Evidence of Coverage on our Medicare Resources page or call Member Services at 1-888-343-3547 (TTY: 711).
Pharmacy Directory
Use the Provider and Pharmacy Directory to find pharmacies that participate in your Wellcare By Fidelis Care plan. You can view, download or print the directory for your plan.
You can also use the Find a Provider or Pharmacy search tool to locate a network pharmacy near you.
Prescription Reimbursement
To ask us to reimburse you for prescriptions you paid for out of pocket, complete the following steps:
- Complete the Prescription Drug Claim Form using the link below.
- If another person will complete the form on your behalf, include the Appointment of Representative Form, CMS-1696, with your Prescription Drug Claim Form. This form is available through the link below and on the Centers for Medicare & Medicaid Services (CMS) website.
- Add the prescription label information to the form and include proof of payment for each claim you submit. If you do not have a receipt or the information needed to complete the form, ask your pharmacy for assistance.
- Mail the completed form or forms and receipt or receipts to the address listed on the form. You must submit your claim within three years of the date you received the drug.
- Keep a copy of the forms and receipts for your records.
Prescription Drug Claim Form
Appointment of Representative Forms
After we receive your request, we will mail our coverage decision, along with a reimbursement check if applicable, within 14 days.
For specific information about your drug coverage, refer to your Evidence of Coverage on our Medicare Resources page or call Member Services at 1-888-343-3547 (TTY: 711).
For more information about requesting prescription reimbursement, visit our Coverage Determinations and Redeterminations for Drugs page.
Mail Order Service
You can fill your prescription at any network pharmacy. You can also receive prescriptions through our preferred mail order service, Express Scripts. 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 Information
For more information about in-network drug coverage, out-of-network pharmacies, specialty pharmacies, mail order service, prescription claims or using the Find a Provider or Pharmacy tool, refer to your Evidence of Coverage on our Medicare Resources page.
You can also call Member Services at 1-888-343-3547 (TTY: 711). We are here to help.