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 Prescription Drug Coverage.
Fax: Complete a coverage determination request and fax it to 1-866-388-1767.
Mail: Complete a coverage determination request 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

Basis for Requests
Providers may request an addition or exception for the following:

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

Basis for Requests

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.

Basis for Requests
Providers may request an addition or exception for the following:

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

For injectable infusion coverage determination requests, please use this form:

WellCare Injectable Infusion

Basis for Requests
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.

Basis for Requests
Providers may request an addition or exception for the following:
- 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
For injectable infusion coverage determination requests, please use this form:
- WellCare Injectable Infusion