What Is In a Medicare Formulary?
A formulary is a list of medications that are covered by a Medicare Advantage (also known as Medicare Part C) plan that includes prescription drug coverage. The vast majority of Medicare Advantage plans cover prescription drugs.1
The drugs in a Wellcare Medicare Advantage plan formulary are typically split into different tiers.
- Drugs on lower tiers are typically generic drugs that are commonly prescribed by doctors.
- Drugs on higher tiers are usually name brand medications and drugs that are more rarely prescribed.
You can shop for Wellcare Medicare Advantage plans with $0 or low copays on generic drugs.
Standalone Medicare Part D prescription drug plans (PDPs) also feature drug formularies.
What Types of Drugs Are Included in a Wellcare Medicare Formulary?
A Wellcare Medicare drug formulary, like all Medicare plan formularies, must cover all available drugs in the following categories:
- HIV/AIDS treatment
- Antipsychotic medications
- Anticonvulsive treatments for seizure disorders
- Immunosuppressant drugs
- Anticancer drugs not covered by Medicare Part B
- Vaccines not covered by Medicare Part B2
In addition to the above mandated coverage, Wellcare Medicare Advantage plans typically cover a wide variety of medications commonly used by senior adults. Covered drugs must be FDA-approved, medically necessary and available only by prescription.
You can also shop for Wellcare Medicare Advantage plans that offer over-the-counter allowances for things like vitamins, toothpaste and incontinence supplies.
What Types of Drugs Are Not Included in a Medicare Formulary?
Certain types of drugs may be excluded from most Medicare drug formularies:
- Weight loss medication
- Drugs primarily used for cosmetic purposes
- Fertility drugs
- Drugs for erectile dysfunction
- Drugs purchased outside the U.S.
Each Wellcare Medicare Advantage plan drug formulary may vary, so be sure to consult with your plan explanation of coverage and formulary to learn which drugs are covered by your plan.
What if a Drug Is Not Included on a Wellcare Medicare Plan Formulary?
If a particular drug is not included in your Medicare Advantage plan formulary, you may be able to ask if plan covers similar drugs. If there are similar drugs covered by the plan, you may be to speak to your doctor about your options.
Can a Medicare Formulary Change?
Medicare drug formularies can change from one year to the next. A drug may be added or dropped from the formulary, or a drug may be moved to a different tier.
Wellcare Medicare Advantage plan members will receive an annual notice of change each fall. This letter informs you if any changes will be made to your plan formulary or plan benefits for the upcoming plan year.
Will My Pharmacy Accept My Wellcare Medicare Advantage Plan?
A Wellcare Medicare Advantage prescription drug plan may be used at participating pharmacies within the Wellcare provider network. You can check with your plan to find out which local pharmacies are part of the network.
You may also be able to order covered drugs through the mail to be delivered right to your door.
How Do I Find a Wellcare Medicare Formulary?
You can find the drug formulary for a Wellcare Medicare Advantage plan in the plan’s summary of benefits. We can help you find out if a Wellcare Medicare plan available in your area covers your drugs.
You can also view the Wellcare Medicare formulary online.3 This formulary applies to select Wellcare Medicare Advantage plans and Medicare Part D plans. Each plan’s individual formulary and the plans available where you live may vary.
How Can I Learn More About Wellcare Medicare Drug Coverage?
We’re here to simplify your Medicare shopping experience and help you learn about the Wellcare Medicare Advantage plans available where you live.
We can help you compare local Medicare Advantage plans side by side so you can shop for a Wellcare plan that covers your prescription drugs.