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Coverage Determination Request

You may request a coverage decision and/or exception any of the following ways:
  
Electronic Prior Authorization (ePA): Cover My Meds
Online: Complete our online Request for Medicare Prescription Drug Coverage Determination.
FaxComplete a coverage determination request Este documento PDF se abrirá en una ventana nueva. and fax it to 1-866-388-1767.
MailComplete a coverage determination request Este documento PDF se abrirá en una ventana nueva. and send it to:

WellCare, Pharmacy-Coverage Determinations
P.O. Box 31397
Tampa, FL 33631-3397

For Overnight Requests:

WellCare, Pharmacy-Coverage Determinations
8735 Henderson Road, Ren. 4
Tampa, FL 33634

Injectable Infusion

For coverage determination requests, please use the Wellcare Injectable Infusion Este documento PDF se abrirá en una ventana nueva. form.

Basis for Requests

This process ensures that medication regimens that are high risk, have a high potential for misuse or have narrow therapeutic indices are used appropriately and according to FDA-approved indications. Coverage Determination Request may request an addition or exception for:

  • Drugs not listed in the Formulary
  • Duplication of therapy
  • Prescriptions that exceed the FDA daily or monthly quantity limit
  • Most self-injectable and infusion medications 
  • Drugs that have an age edit
  • Drugs listed on the PDL but still requiring Prior Authorization (PA)
  • Brand name drugs when a generic exists
  • Drugs that have a step edit (ST) and the first-line therapy is inappropriate
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Last Updated On: 7/11/2022