Our List of Drugs (Formulary) shows the drugs we cover. The list includes:
In general, we cover drugs if they are medically necessary. Drugs on the List of Drugs (Formulary) are covered when you use our network pharmacies or mail order program for maintenance drugs. Maintenance drugs are drugs you take for a chronic or long-term condition. Some drugs we cover have limits or other rules.
The Pharmacy and Therapeutics Committee, our team of independent healthcare experts, reviews and approves the list of drugs. We don’t include all drugs. Some drugs may not be covered or are excluded. Other drugs are not on the list because of clinical and cost reasons.
You can search for a drug by using either the drug search tool by clicking the link below or by opening the List of Drugs (Formulary) PDF document below. Each option gives you a complete list of covered drugs and any restrictions or limits. The search tool also shows you covered drug alternatives.
The PDF document lists drugs by medical condition and alphabetically within the index. To search for your drug in the PDF, hold down the “Control” (Ctrl) and “F” keys. When the search box appears, type the name of your drug. Press the “Enter” key. You also have the option to print the drug list as a PDF document. The drug list is updated monthly.
Updated Date September 3, 2024:
Drugs may be added or removed from our list of drugs during the year. Generally, we will tell you before we make one of the following changes to the list of drugs.
If the Food and Drug Administration (FDA) or the drug’s maker says a drug is not safe, it will be removed from our list of drugs right away. In addition, if a new generic drug comes to market, we may remove the brand name drug. To view the changes, open the List of Drug Change Notice PDF document below.
You can ask us to make an exception to our coverage rules for your drug(s). To learn about the types of exceptions, refer to your Member Handbook. When asking for an exception, include a statement from your doctor that supports your request, plus a completed Coverage Determination form.
Generally, we must decide on your request within 72 hours after we get your doctor’s statement. You or your doctor can request a fast (expedited) exception if your health could be seriously harmed by waiting up to 72 hours. If we approve your expedited request, we must give you a decision within 24 hours after we get your doctor’s supporting statement.
We cover both brand name drugs and generic drugs. Generic drugs have the same active ingredient formula as a brand name drug.
Generic drugs are FDA-approved and are as safe and effective as brand name drugs. They have the same active ingredients, indications, dosages, safety, and strengths as the brand name drugs and generally cost less. Ask your doctor if any of your drugs are available as a generic, and if a generic version will work for you.
You can fill your prescription at any network pharmacy. You also can fill your prescription through our preferred mail order service—Express Scripts® Pharmacy. You can find more information about receiving your prescriptions through mail service delivery on our Mail Order Service page.
If you have questions about our list of drugs, or want the most recent version, please contact Member Services. We are here to help.
Our List of Drugs (Formulary) shows the drugs we cover. The list includes:
In general, we cover drugs if they are medically necessary. Drugs on the List of Drugs (Formulary) are covered when you use our network pharmacies or preferred mail order service for maintenance drugs. Maintenance drugs are drugs you take for a chronic or long-term condition. Some drugs we cover have limits or other rules.
The Pharmacy and Therapeutics Committee, our team of independent healthcare experts, reviews and approves the list of drugs. We don’t include all drugs. Some drugs may not be covered or are excluded. Other drugs are not on the list because of clinical and cost reasons.
You can search for a drug by using our Drug Search Tool or by opening the List of Drugs (Formulary) PDF document. Each option gives you a complete list of covered drugs and any restrictions or limits. The search tool also shows you covered drug alternatives.
The PDF document lists drugs by medical condition and alphabetically within the index. To search for your drug in the PDF, hold down the “Control” (Ctrl) and “F” keys. When the search box appears, type the name of your drug. Press the “Enter” key. You also have the option to print the PDF drug list. The drug list is updated monthly.
Drugs may be added or removed from our list of drugs during the year. Generally, we will tell you before we make any of the following changes:
If the Food and Drug Administration (FDA) or the drug’s maker says a drug is not safe, it will be removed from our list of drugs right away. In addition, if a new generic drug comes to market, we may remove the brand name drug. To view the changes, open the List of Drug Change Notice PDF document below.
You can ask us to make an exception to our coverage rules for your drug(s). To learn about the types of exceptions, refer to your Member Handbook. When asking for an exception, include a statement from your doctor that supports your request, plus a completed Coverage Determination form.
Generally, we must decide on your request within 72 hours after we get your doctor’s statement. You or your doctor can request a fast (expedited) exception if your health could be seriously harmed by waiting up to 72 hours. If we approve your expedited request, we must give you a decision within 24 hours after we get your doctor’s supporting statement.
We cover both brand name drugs and generic drugs. Generic drugs have the same active ingredient formula as a brand name drug.
Generic drugs are FDA-approved and are as safe and effective as brand name drugs. They have the same active ingredients, indications, dosages, safety, and strengths as the brand name drugs and generally cost less. Ask your doctor if any of your drugs are available as a generic, and if a generic version will work for you.
You can fill your prescription at any network pharmacy. You also can fill your prescription through our preferred mail order service—Express Scripts® Pharmacy. You can find more information about receiving your prescriptions through mail service delivery on our Mail Order Service page.
If you have questions about our list of drugs, or want the most recent version, contact Member Services. We are here to help.
Last updated: 10/01/2023
Material ID: H1723_WEBSITE_2024_Approved_10252023
Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and South Carolina Healthy Connections Medicaid to provide benefits of both programs to enrollees.
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Wellcare Prime Member Handbook.
Out-of-network/non-contracted providers are under no obligation to treat Wellcare Prime members, except in emergency situations. Please call our Member Services number or see your Member Handbook for more information, including the cost-sharing that applies to out-of-network services.
Other pharmacies/physicians/providers are available in our network.
If you need help finding a network provider and/or pharmacy, please call 1-855-735-4398 (TTY: 711) or visit mmp.absolutetotalcare.com to access our online searchable directory. If you would like a Provider/Pharmacy Directory mailed to you, you may call the number above, request one at the website link provided above, or email ATC_SC_MMP@centene.com.
Last updated: 10/01/2023
Material ID: H1723_WEBSITE_2024_Approved_10252023
Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and South Carolina Healthy Connections Medicaid to provide benefits of both programs to enrollees.
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Wellcare Prime Member Handbook.
Out-of-network/non-contracted providers are under no obligation to treat Wellcare Prime members, except in emergency situations. Please call our Member Services number or see your Member Handbook for more information, including the cost-sharing that applies to out-of-network services.
Other pharmacies/physicians/providers are available in our network.
If you need help finding a network provider and/or pharmacy, please call 1-855-735-4398 (TTY: 711) or visit mmp.absolutetotalcare.com to access our online searchable directory. If you would like a Provider/Pharmacy Directory mailed to you, you may call the number above, request one at the website link provided above, or email ATC_SC_MMP@centene.com.