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Wellcare Meridian Health Dual Access (HMO-POS D-SNP)

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Parmasya

Our members have access to many 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.

Find a Provider/Pharmacy
Network Pharmacies
Specialty Pharmacy
Out-of-Network Pharmacies
Mail Order Services
Prescription Reimbursement
Pharmacy Directory

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/Pharmacy search tool. You can also download or print a copy of the Pharmacy Directory. If you need help, please Contact Us.

For more information about filling your prescriptions at network pharmacies, please refer to your Evidence of Coverage or Contact Us.

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, H.I.V. or hemophilia. Specialty pharmacies can help you to manage side effects and symptoms, ensure you take your medications on time and as prescribed, and assist you with 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/Pharmacy search tool. You can also download or print a copy of the Pharmacy Directory. If you need help, please Contact Us.

Not all specialty pharmacies carry every drug. What they offer depends on the drug and your plan. Before you transfer or fill a new prescription, call the specialty pharmacy you choose to confirm they can fill your prescription.

For more information on our specialty pharmacies, please refer to your Evidence of Coverage or Contact Us.

Mga Parmasyang Wala sa Network

We have thousands of pharmacies in our nationwide network to make it easy to get your prescription drugs. Using a network pharmacy is usually the best option to lower costs and reduce paperwork. 

However, we know there may be times when you can't use a network pharmacy. We may cover your prescription filled at an out-of-network pharmacy if:

  • Walang bukas na parmasyang nasa network na malapit sa inyo, o
  • Kailangan ninyo ng gamot na hindi ninyo makukuha sa isang parmasyang nasa network na malapit sa inyo, o
  • Kailangan ninyo ng gamot para sa emergency o agarang pangangalagang medikal, o
  • You must leave your home due to a federal disaster or other public health emergency.

Always Contact Us first or use the Find a Provider/Pharmacy tool to check if there is a network pharmacy near you.

Traveling or Away from Home
If you take a prescription drug on a regular basis and are planning to travel, be sure to 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 territories, we may cover your drug at an out-of-network pharmacy for the same reasons as noted above. However, we cannot pay for any prescriptions filled outside of the United States and its territories, including prescriptions filled while traveling on cruises, even for 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 pay you back for our share of the cost. Approval is not guaranteed.

Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please Contact Us or refer to your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. 

Reimbursement ng Reseta

If you need to ask us to pay you back for prescriptions paid out of pocket:

  1. Complete the Prescription Drug Claim Form using the link below.
  2. If you want another person to complete this form on your behalf, please include the Appointment of Representative (AOR) Form CMS-1696 with your Prescription Drug Claim Form. This form is located at the link below and can also be found on the Centers for Medicare & Medicaid Services (CMS) website.
  3. Add the prescription label information to the form and include a proof of payment receipt with each claim form you submit. If you do not have the receipt or the information needed to fill out the form, you can ask your pharmacy to help.
  4. Mail the completed form(s) and receipt(s) to the address on the form. You must submit your claim to us within three years of the date you received your drug.
  5. It is also a good idea to keep a copy of the forms and receipts for your records.

Pagkatanggap namin sa inyong kahilingan, ipapadala namin sa mail ang aming desisyon (pagpapasya sa pagsaklaw) kasama ang isang reimbursement check (kung naaangkop) sa loob ng 14 na araw. 

For specific information about drug coverage, please refer to your Evidence of Coverage or Contact Us. We are here to help. 

Serbisyo ng Mail Order

You can fill your prescription at any network pharmacy. You can also fill your prescription through our preferred mail order service Express Scripts. This can save you time, money, and trips to the pharmacy.

Find more information about receiving your prescriptions through mail service delivery on the Mail Order Service page.

For additional information about in-network drug coverage, using an out-of-network pharmacy, specialty pharmacy, mail order service, prescription claims, or using our Find a Provider/Pharmacy tool, please refer to your Evidence of Coverage or Contact Us. We are here to help.

Impormasyon tungkol sa Parmasya

Request for Medicare Prescription Drug Coverage Determination

You can use one of the determination forms to complete a Medicare drug coverage request:

Electronic: Complete this electronic form via our website.
Drug Coverage Determination Request – Online Form 

Printable: Complete and fax or mail the form to us.
Drug Coverage Determination Request Form – English (PDF)
Drug Coverage Determination Request Form – Spanish (PDF)

Request for Redetermination of Medicare Prescription Drug Denial (Appeal)

You can use one of the redetermination forms to complete a request for redetermination of Medicare prescription drug denial:

Electronic: Complete this electronic form via our website.
Redetermination Request for Part D Denials – Online Form

Printable: Complete and fax or mail the form to us.
Redetermination Request for Part D Denials – English (PDF)
Redetermination Request for Part D Denials – Spanish (PDF)

Matuto Pa

Learn more about Medicare coverage determinations (exceptions) and redeterminations (appeals) on the Centers for Medicare & Medicaid Services website.

Pag-fill sa Iyong Reseta

When you fill your prescription at a participating pharmacy, you will simply need to present your Wellcare Member ID card. You will be responsible for any necessary out-of-pocket expense, if any, according to your Part D benefit.

Learn more about receiving your prescriptions through mail service delivery on the following page:

Did you fill a prescription at a pharmacy outside our network?

Learn more about our out-of-network coverage and filling your prescription. Refer to the Evidence of Coverage under Plan Materials.

Serbisyo ng Mail Order

You can fill your prescription at any network pharmacy. You also can fill your prescription through our preferred mail order service. This can save you time, money, and trips to the pharmacy.

Learn more about receiving your prescriptions through mail service delivery on the following page:

Specialty Pharmacy

Available ang aming mga may espesyalidad na parmasya nang walang dagdag na gastos para sa miyembrong umiinom ng mga gamot bilang lunas sa mga pangmatagalan, kumplikado, o pambihirang chronic na kondisyon gaya ng cancer, rheumatoid arthritis, H.I.V. o hemophilia. Matutulungan namin kayo na makontrol ang mga side effect at sintomas, tiyaking naiinom ninyo sa tamang oras at paraan ang mga gamot, at makapagpa-refill.

Our specialty pharmacy networks include:

Para sa lahat ng may espesyalidad na parmasya, dapat tawagan ng mga user ng TTY/TTD ang: 711

Other in-network specialty pharmacies may be available depending on your plan. Find a network pharmacy near you by using our Find a Provider/Pharmacy search tool. You can also download or print a copy of the Pharmacy Directory. If you need help, please Contact Us.

Not all specialty pharmacies carry every drug. What they offer depends on the drug and your plan. Before you transfer or fill a new prescription, call the specialty pharmacy you choose to confirm they can fill your prescription.

For more information on our specialty pharmacies, please refer to your Evidence of Coverage or, Contact Us.

  • Coverage Determination/ Redetermination

    Request for Medicare Prescription Drug Coverage Determination

    You can use one of the determination forms to complete a Medicare drug coverage request:

    Electronic: Complete this electronic form via our website.
    Drug Coverage Determination Request – Online Form 

    Printable: Complete and fax or mail the form to us.
    Drug Coverage Determination Request Form – English (PDF)
    Drug Coverage Determination Request Form – Spanish (PDF)

    Request for Redetermination of Medicare Prescription Drug Denial (Appeal)

    You can use one of the redetermination forms to complete a request for redetermination of Medicare prescription drug denial:

    Electronic: Complete this electronic form via our website.
    Redetermination Request for Part D Denials – Online Form

    Printable: Complete and fax or mail the form to us.
    Redetermination Request for Part D Denials – English (PDF)
    Redetermination Request for Part D Denials – Spanish (PDF)

    Matuto Pa

    Learn more about Medicare coverage determinations (exceptions) and redeterminations (appeals) on the Centers for Medicare & Medicaid Services website.

  • Pag-fill sa Iyong Reseta

    Pag-fill sa Iyong Reseta

    When you fill your prescription at a participating pharmacy, you will simply need to present your Wellcare Member ID card. You will be responsible for any necessary out-of-pocket expense, if any, according to your Part D benefit.

    Learn more about receiving your prescriptions through mail service delivery on the following page:

    Did you fill a prescription at a pharmacy outside our network?

    Learn more about our out-of-network coverage and filling your prescription. Refer to the Evidence of Coverage under Plan Materials.

  • Mail Order Service

    Serbisyo ng Mail Order

    You can fill your prescription at any network pharmacy. You also can fill your prescription through our preferred mail order service. This can save you time, money, and trips to the pharmacy.

    Learn more about receiving your prescriptions through mail service delivery on the following page:

  • Specialty Pharmacy

    Specialty Pharmacy

    Available ang aming mga may espesyalidad na parmasya nang walang dagdag na gastos para sa miyembrong umiinom ng mga gamot bilang lunas sa mga pangmatagalan, kumplikado, o pambihirang chronic na kondisyon gaya ng cancer, rheumatoid arthritis, H.I.V. o hemophilia. Matutulungan namin kayo na makontrol ang mga side effect at sintomas, tiyaking naiinom ninyo sa tamang oras at paraan ang mga gamot, at makapagpa-refill.

    Our specialty pharmacy networks include:

    Para sa lahat ng may espesyalidad na parmasya, dapat tawagan ng mga user ng TTY/TTD ang: 711

    Other in-network specialty pharmacies may be available depending on your plan. Find a network pharmacy near you by using our Find a Provider/Pharmacy search tool. You can also download or print a copy of the Pharmacy Directory. If you need help, please Contact Us.

    Not all specialty pharmacies carry every drug. What they offer depends on the drug and your plan. Before you transfer or fill a new prescription, call the specialty pharmacy you choose to confirm they can fill your prescription.

    For more information on our specialty pharmacies, please refer to your Evidence of Coverage or, Contact Us.


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Y0020_WCM_7577750_M / H9916_WCM 178009E_M Last Updated On: 10/1/2026