Starting January 1, 2026, some drugs will no longer be covered by Wellcare Medicare Part D formulary(ies).
To assist our providers, here’s a list of the most commonly prescribed drugs being removed along with the drug’s 2026 formulary alternative(s).
Please refer to the list to identify the appropriate options for your patients.
|
Product Name |
Formulary Alternative |
| OneTouch | Accu-Chek Guide, True Metrix |
| Insulin Degludec | Insulin Glargine-yfgn, Insulin Glargine U-300 |
| Diclofenac 2% Solution | Diclofenac 1.5% Topical Solution |
| Humira (adalimumab) | Cyltezo (adalimumab-adbm)*, Yuflyma (adalimumab-aaty)*, Tyenne (tocilizumab-aazg)*, Steqeyma (ustekinumab-stba)*, Cosentyx*, Otezla*, Rinvoq*, Skyrizi*, Tremfya* |
| Actemra (tocilizumab) | |
| Austedo, Austedo XR | Tetrabenazine*, Ingrezza* |
| Trulance | Lubiprostone, Linzess |
| Bydureon BCise | Mounjaro*, Ozempic*, Rybelsus*, Trulicity* |
| Gammagard Liquid | Gamunex-C* |
| Xultophy | Soliqua |
| Abiraterone 500mg | Abiraterone 250mg tab*, Abirtega 250mg tab* |
| Fasenra | Dupixent*, Xolair* |
| Vivitrol | Acamprosate, Disulfiram |
| Opsumit | Ambrisentan*, Bosentan*, Sildenafil 20mg*, Tadalafil 20mg* |
| * Prior Authorization Required | |
If a provider determines that it is necessary for their patient to continue to receive the non-formulary drug in 2026, they must submit a Coverage Determination request on or after January 1, 2026.
To find the provider request forms, visit the Coverage Determination Request resource or call to request authorization.
If you have any questions, call Medicare Pharmacy Services at 1-855-538-0454 Monday through Friday from 8 a.m. to 10:30 p.m. Eastern.
Wellcare Provider Resources
Member Services
- Duals Special Needs Plans (DSNP): 1-855-445-3578 (TTY 711)
- Medicare Advantage Prescription Drug (MAPD): 1-833-444-9088 (TTY 711)
Paunang Awtorisasyon
- Visit: Wellcare Authorization Lookup
- Call: 1-855-538-0454 (TTY 711)
- Fax: 1-866-388-1767
Questions?
Wellcare has a wealth of resources available to help answer your questions and address your concerns:
- Provider Support: Finding the Right Contact
- Provider Services: Call 1-855-538-0454
- Secure Provider Portal: Visit the Secure Provider Portal to check member eligibility, submit claims and more.
- Provider Engagement: Use the Find Your Account Manager tool to find the Provider Engagement Account Manager (PEAM) supporting your specialty and region.
- Claim Concerns: Resolve outstanding claims using the Claim Concerns form.
- Provider News: Bookmark Wellcare Provider Bulletins and Sunshine Health Provider News to keep up with the latest updates.
- Provider Newsflash: Subscribe to our e-newsletter to get regular updates.
- Provider Resources: Visit Wellcare Provider Resources to find provider manuals, important forms, scheduling standards and other resources.
