We've got you covered for your prescription drug needs!
Learn more about your pharmacy plan, tips to save money on medications, and pharmacy home delivery. Let's start with the basics.
What is Part D and what does a Part D prescription drug plan cover?
Most Medicare Advantage Plans include Part D coverage. Part D is the part of Medicare that provides coverage for your needed drugs and medications. If you do not have Medicare Part D coverage, you do not have coverage for prescription drugs. Refer to your plan materials for more information about your Part D benefit.
Where can I find my drug list?
Your drug list, also called a formulary, is a list of prescription drugs that may be covered in your health plan. The drug list shows the most comprehensive drugs on your plan and is regularly updated. You can find your drug list in your secure member portal or on your health plan website.
What if my drug is not on the drug list?
If you currently take a drug that is not on your drug list, please check your plan's formulary for details on which alternative drugs are covered. Your health plan website also has an Alternative Drugs List with the most common drug alternatives that are covered by your plan.
Talk to your doctor to see if any alternative drugs will work for you.
How much will I pay for my prescription drugs?
If your plan has a deductible, you will pay the full cost of your medications until your deductible has been met for the year. Your out-of-pocket prescription costs will not exceed $2,000 during the plan year.
Medicare places drugs into different cost levels called “tiers.” Plan types may vary in the number of tiers offered.
On most of our plans, you will pay $0 for Tier 1 and Tier 6 medications, and $0 at preferred pharmacies for Tier 2 medications. We offer a wide variety of generic drugs on these tiers, and also cover generic erectile dysfunction drugs and select vitamins like folic acid, vitamin B12, and vitamin D2.
Other tiers may have a coinsurance where you pay a percentage of the total drug cost. Your costs can vary depending on the drug and pharmacy that you use.
Does my plan cover shots and vaccines?
Yes, all adult, ACIP-recommended Part D vaccines, such as RSV and Shingles, are available at no cost to you.
Does my plan include insulin?
Yes, you can get a 30-day supply of all covered insulins for $35 or less.
Why should I use an in-network pharmacy?
You can save on out-of-pocket drug costs by using a preferred, in-network pharmacy.
We have over 60,000 pharmacies in our network with both local and retail pharmacies for you to choose from. Our partnerships with CVS and Walgreens and most grocers ensure that you can find a preferred, in-network pharmacy that is close to you.
Use the Find a Provider Tool to find a preferred pharmacy near you.
Can I have my prescriptions mailed to my home?
You can save time and trips to the pharmacy through Mail Order Pharmacy. Get up to a 100-day supply of your prescription drugs sent to your home with Express Scripts® Pharmacy. Your prescriptions will be automatically refilled and renewed so you don’t run out of your medication. This service is included with your health plan [at no extra cost to you. Plus, standard shipping is free!
Your prescriptions are delivered to your door in discreet packaging. You can track your medication delivery and get updates by email, phone, or text to make sure you have your medications when you need them.
To get started, call Express Scripts at 1-833-750-0201 (TTY 711) 24 hours a day, 7 days a week, or visit express-scripts.com/rx to register.
What if my medications need prior authorization or pre-approval?
Some medications need prior authorization, or pre-approval, and are noted with a “PA” in your drug list.
If you are prescribed a medication that requires pre-approval, your doctor will need to submit a prior authorization form requesting the drug for you.
What if I can’t afford my medications?
If you're having a hard time paying for the prescription drugs you need, don’t stop taking your medicine or reducing the amount you take. Taking your medication as prescribed by your doctor helps keep you healthy. Talk to your doctor about your [medication options]. Your doctor can recommend drugs that may cost less and may work better for you.
<The Medicare Prescription Payment Plan is a new payment option that works with your current drug coverage and can help you manage your drug costs by spreading them across monthly payments that vary throughout the year from January to December. To learn more, visit www.wellcare.com/MPPP.
Additional questions?
If you have questions about your pharmacy benefits or coverage, please call the Member Services number on the back of your Member ID card.
From April 1 to September 30, you can call between 8 am and 8 pm Monday thru Friday.
From October 1 to March 31, you can call between 8 am and 8 pm every day.
