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Pharmacy

Below are a variety of pharmacy-related links and tools for your use.

Medication Guide/Formulary

Providers can search through a list of prescription drugs covered by our pharmacy plan:

For any drugs not listed, you may request that we consider it for inclusion by submitting medical justification in writing to:

Wellcare By ‘Ohana Health Plans, Clinical Pharmacy Department
Director of Formulary Services
Pharmacy and Therapeutics Committee
PO Box 31577
Tampa, FL 33631-3577

Coverage Determination

The coverage determination process enables providers to request an addition or exception.

AcariaHealth Specialty Pharmacy

This service is available at no additional cost to patients undergoing treatment for long-term, life-threatening or rare conditions.


Pharmacy Forms

We strive to cover the most common drugs across all conditions. Below are some common drugs not covered by the plan, along with alternative drugs that are covered. If your patient is currently on a drug that is not covered, please see if the formulary alternatives listed below would work for your patient.

Drug Prior Authorization Requests Supplied by the Physician/Facility

This policy provides a list of drugs that require step therapy effective January 1, 2024. Step therapy is when we require the trial of a preferred therapeutic alternative prior to coverage of a non-preferred drug for a specific indication.

MCPB.ST.00: This policy provides a list of drugs that require step therapy.

Reference Guides


Contains key phone numbers and information on claims, appeals and more.

Pharmacy Clinical Policies

Crizanlizumab-tmca (Adakveo®) is a selectin blocker.

Cerliponase alfa (Brineura®) is a hydrolytic lysosomal N-terminal tripeptidyl peptidase.

The following are factor VIII products requiring prior authorization: human – Hemofil M®, Koate-DVI®; recombinant – Advate®, Adynovate®, Afstyla®, Eloctate®, Esperoct®, Helixate FS®, Jivi®, Kogenate FS®, Kogenate FS with Vial Adapter®, Kogenate FS with Bio-Set®, Kovaltry®, NovoEight®, Nuwiq®, Obizur®, Recombinate®, ReFacto®, Xyntha®, and Xyntha® Solofuse™.

Factor VIIa, recombinant (NovoSeven® RT) and coagulation factor VIIa (recombinant)-jncw (SevenFact®) are coagulation factors.

Patisiran (Onpattro™) is a double-stranded small interfering ribonucleic acid, formulated as a lipid complex for delivery to hepatocytes.

Mogamulizumab-kpkc (Poteligeo®) is a CC chemokine receptor type 4 (CCR4)-directed monoclonal antibody.

Eculizumab (Soliris®) is a complement inhibitor.

Trientine (Syprine®) is a chelating agent.

Ravulizuamb-cwvz (Ultomiris®) is a complement inhibitor.

Golodirsen (Vyondys 53TM) is an antisense oligonucleotide.

Helpful Information

Pharmacy Forms

Access key forms for doing business with 'Ohana Health Plan.

NDC Reporting Guidelines

Access NDC Reporting Guidelines This PDF document will open in a new window..

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