Who May Make a Request
Your prescriber may ask us for a coverage determination on your behalf. If you want another individual (such as a family member or friend) to make a request for you,
that individual must be your representative. Contact Us to learn how to name a representative.
Request for Medicare Prescription Drug Determination This form may be sent to us by mail or fax:
| Wellcare Health Plans
P.O. Box 31397
Tampa, FL 33631
You may also ask us for a coverage determination by phone at 1-888-550-5252.