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The WellCare Pharmacy Services team is committed to quality service and partnership with our providers to improve our members’ health and well-being. To help your patients get the most out of their pharmacy benefit, please consider the following when prescribing:
Preferred Drug List (PDL)
The PDL is a clinical guide of prescription drug products selected by the Pharmaceutical and Therapeutics (P&T) Committee based on the drug’s efficacy, safety, side effects, pharmacokinetics, clinical literature and cost-effectiveness profile. Most medications are covered without prior authorization, however the PDL denotes any of the pharmacy utilization management tools that apply to a particular pharmaceutical when applicable. These materials may change over time so please check back to make sure you have the most up-to-date version of the PDLs.
Note: DME and medical supplies are reviewed and, as applicable, approved, through WellCare’s DME Services. Diabetic supplies, including meters, strips, lancets and alcohol swabs, are covered by Pharmacy Services. Refer to your Quick Reference Guide for contact information.
Pharmacy Utilization Management Tools
Our pharmaceutical management procedures are integral in ensuring and promoting the utilization of the most clinically appropriate agent(s) to improve the health and well-being of our members. To request an evaluation of a pharmaceutical that: is not on the PDL, has an age edit, exceeds established quantity limits, is a brand name when a generic exists, or requires a prior authorization or step edit, please submit a Drug Evaluation Review form. Additional request forms can be accessed on the Forms and Documents page.
Expedited requests and an emergency supply of medication will be completed within 24 hours. Refer to your Quick Reference Guide for the Pharmacy Services contact information. In the event your non-emergent DER request is denied, you have the right to submit an appeal.
For more information on coverage limitations and Pharmacy utilization management tools, refer to your Provider Manual.
We encourage providers to alert members they can receive a monthly credit of up to $10 per household for personal care products delivered right to their home. Examples include items such as vitamins and cough medicine.
WellCare’s medical injectables prior authorization requirements are aligned with current industry practice. Most self-injectable and infusion medications require prior authorization. Use our authorization look-up tool to search quickly and easily by CPT code.
WellCare Specialty Pharmacy
WellCare offers Specialty Pharmacy services to members who are taking medications to treat long-term, life-threatening or rare conditions. WellCare’s Specialty Pharmacy team offers experts in the special handling, storage and administration of these medications (i.e., injectables, infusables, orals). This team knows the insurance process and the member’s plan benefits, meaning less chance of delay in a member receiving their needed medication(s). Refer to Specialty Pharmacy site to learn more about the conditions covered, and how to contact the team.
WellCare of Kentucky Pharmacy and Therapeutics Advisory Forum
The WellCare Pharmacy and Therapeutics Advisory Forum meets once every quarter to review and make recommendations for the placement of products on the WellCare of Kentucky Preferred Drug List (PDL).
Meetings are open and persons wishing to speak on an agenda item must submit a Speaker Request Form no later than seven (7) business days prior to the meeting.
Please note: The next meeting is scheduled for August 5, 2015. Please see our agenda for further details on location, times and topics.
Previous meeting agendas: