Formulary ID Number: 21096, Version 3. The benefit information provided is a brief summary, not a complete description of benefits. We make every attempt to keep our information up-to-date with plan/premium changes. 2021 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. Get information about a list of drugs covered by WellCare. (AKA "donut hole") You will still receive a 75% discount on covered brand-name drugs and a discount on generic drugs. New for 2021: This plan participates in the Part D Senior Savings Model for Insulin. Medicare evaluates plans based on a 5-Star rating system. Formulary drug lists. The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change. (combined amount plus your deductible) You will be in the coverage gap. There are three ways to search: Alphabetical Search Click on the first letter of the drug you are searching. '//cse.google.com/cse.js?cx=' + cx; Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Providers, please visit our website … We are an independent education, research, and technology company. Plan Name: This is the official Medicare Part D prescription drug or Medicare … 02/01/2021 ©WellCare 2020 NA1WCMFOR68279E_CV16 2021 Comprehensive Formulary (List of Covered Drugs) WellCare Absolute (PPO) Plan in the following states: NC, SC WellCare Choice (HMO) Plan in the following state: GA WellCare Elite (HMO) Plan in the following state: SC WellCare Premier (PPO) Plan in the following states: GA, SC WellCare Prime (PPO) Plan in the following state: GA WellCare … See Evidence of Coverage for complete details. (combined amount plus your deductible) You will be in the coverage gap. That means whenever you have a prescription filled, the amount you pay depends on what tier or level the drug is on. })(); Use your drug discount card to save on medications for the entire family ‐ including your pets. You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. var s = document.getElementsByTagName('script')[0]; In 2021 once you and your plan provider have spent $4130 on covered drugs. Medicare MSA Plans do not cover prescription drugs. area. Members may enroll in a Medicare Advantage plan only during specific times of the year. during the calendar year will owe a portion of the account deposit back to the plan. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. (function() { Please note: The above plan information comes from CMS. Brand and Generic Name Search Type the drug name you are searching in the box.. var cx = 'partner-pub-9185979746634162:fhatcw-ivsf'; 2021 South Carolina Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) WellCare of South Carolina 00 Please read: This document contains information about the drugs we cover in this plan. TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult. WellCare Preferred Drug List Search Tool. Contact the plan provider for additional information. ; Brand and Generic Name Search Type the drug name you are searching in the box.. Below is the Formulary, or drug list, for WellCare Value Script (PDP) from Wellcare Prescription Insurance, Inc.. A formulary is a list of prescription medications that are covered under Wellcare Prescription Insurance, Inc.'s In Oregon, Washington. during the calendar year will owe a portion of the account deposit back to the plan. ... 2021 Medicare Basics; 2021 Medication Therapy Management ; Cost Calculator Tool; Member Login; Prescription Drug Plans. Therapeutic Class Search Choose the therapeutic class (what the drug does and how it’s used) of the drug you are searching. This formulary was updated on 2/1/2021. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. Limitations, copayments, and restrictions may apply. Back to top. Please note that the WellCare of Kentucky Supplemental Medicaid Preferred Drug List is updated quarterly. s.parentNode.insertBefore(gcse, s); Medicare has neither reviewed nor endorsed the information on our site. Some benefit plans have a tiered design. Key UPPER CASE = Brand Name Drugs QL = … Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition. Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home. You should always verify cost and coverage information with your Medicare plan provider. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. WC02201237 WC - MCD_Provider_Kentucky_PDL 1/01/2021 2021 Kentucky Supplemental Medicaid Preferred Drug List (List of Covered Drugs) WellCare of Kentucky 00 Please read: This document contains information about the drugs we cover in this plan. FormularyID, (Chart Source: Centers for Medicare and Medicaid files: CMS Data January 2021 ). Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. (combined amount plus your deductible) You will be in the coverage gap. 2021 WellCare of Georgia Comprehensive Preferred Drug List (List of Covered Drugs) WellCare of Georgia Families Please read: This document tells about the drugs we cover in this plan. Below are a few notes to help you understand the above 2021 Medicare Part D WellCare … 2021 WellCare of Georgia Comprehensive Preferred Drug List (List of Covered Drugs) WellCare of Georgia Families Please read: This document tells about the drugs we cover in this plan. Alphabetical Search Skip to Brand & Generic Search Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). (AKA "donut hole") You will still receive a 75% discount on covered brand-name drugs and a discount on generic drugs. 24 hours a day/7 days a week or consult, When enrolling in a Medicare Advantage plan, you must continue to pay your. Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at, Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the. MA-Compare: Review Changes in each 2020 Medicare Advantage Plan for 2021, Find a 2021 Medicare Part D Plan (PDP-Finder: Rx Only), Q1Rx 2021 Medicare Part D or Medicare Advantage Plan Finder by Drug, Guided Help Finding a 2021 Medicare Prescription Drug Plan, Search for 2021 Medicare Plans by Plan ID, Search for 2021 Medicare Plans by Formulary ID, 2021 Medicare Prescription Drug Plan (PDP) Benefit Details, 2021 Medicare Advantage Plan Benefit Details, Medicare plan quality and CMS Star Ratings, Understanding Your Explanation of Benefits, IRMAA: Higher premiums for higher incomes, 2021 Medicare Advantage Plans State Overview, Find a 2021 Medicare Advantage Plan by Drug Costs, » Learn more about savings on Pet Medications, Example: AARP MedicareRx Preferred (PDP) Formulary in Florida, Abacavir Sulfate-Lamivudine-Zidovudine tablets [Trizivir], ABACAVIR-LAMIVUDINE 600-300 MG TABLET [Epzicom], ABIRATERONE ACETATE 250 MG TABLET [ZYTIGA], Acamprosate Calcium DR 333 MG tablets [Campral], ACETAMINOPHEN-COD #3 TABLET [Tylenol with Codeine No.3], ACETYLCYSTEINE 20% VIAL [Mucosil Acetylcysteine], ADALIMUMAB 50 MG/ML PREFILLED SYRINGE [HUMIRA], ADEFOVIR DIPIVOXIL 10 MG TABLET [Hepsera], ADVAIR HFA 230; 21ug/1; ug/1 120 AEROSOL, METERED in 1 INHALER, ADVAIR HFA INHALER 115;21MCG;MCG 120 ACTN INHL, ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL, ALBUTEROL HFA 90 MCG INHALER HFA AER AD [Ventolin HFA], ALBUTEROL SUL 2.5 MG/3 ML SOLUTION VIAL-NEB, ALCLOMETASONE DIPR 0.05% OINTMENT [Aclovate], ALENDRONATE SODIUM 10 MG TABLET [Fosamax], ALENDRONATE SODIUM 35 MG TABLET [Fosamax], ALENDRONATE SODIUM 70 MG TABLET [Fosamax], Amabelz 0.5 MG/0.1 MG 28 TABLET/BLISTER PACK 3 PER CARTON, Amabelz 1 MG/0.5 MG 28 TABLET/BLISTER PACK 3 PER CARTON, AMILORIDE HCL-HCTZ 5-50 MG TABLET [Moduretic], Amino acids 4.25% in dextrose 10% Injectable Solution [Clinimix 4.25/10], Amino acids 4.25% in dextrose 5% Injectable Solution [Clinimix 4.25/5], AMLODIPINE BESYLATE 10 MG TABLET [Norvasc], AMLODIPINE BESYLATE 2.5 MG TABLET [Norvasc], AMLODIPINE BESYLATE 5 MG TABLET [Norvasc], AMLODIPINE-BENAZEPRIL 10-20 MG CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 10-40 MG CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 2.5-10 CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 5-10 MG CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 5-20 MG CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 5-40 MG CAPSULE [Lotrel], AMLODIPINE-VALSARTAN 10-160 MG TABLET [Exforge], AMLODIPINE-VALSARTAN 10-320 MG TABLET [Exforge], AMLODIPINE-VALSARTAN 5-160 MG TABLET [Exforge], AMLODIPINE-VALSARTAN 5-320 MG TABLET [Exforge], AMMONIUM LACTATE 12% CREAM (g) [Lac-Hydrin], AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE [Augmentin], AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET [Augmentin], AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE [Augmentin], AMOX-CLAV 400-57 MG/5 ML ORAL SUSPENSION [Augmentin], AMOXICILLIN 200 MG/5 ML ORAL SUSPENSION [Amoxil], AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION [Trimox], AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION [Amoxil], Ampicillin 1000 MG / Sulbactam 500 MG Injection, Ampicillin 125mg/1 10 VIAL, GLASS in 1 PACKAGE / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, GLASS, Anagrelide Hydrochloride 0.5mg/1 100 CAPSULE BOTTLE, Anagrelide Hydrochloride 1mg/1 100 CAPSULE BOTTLE, ARIPIPRAZOLE ODT 10 MG TABLET RAPDIS [Abilify Discmelt], ARIPIPRAZOLE ODT 15 MG TABLET RAPDIS [Abilify Discmelt], ARISTADA INITIO ER 675 MG/2.4 SUSER SYRINGE, ATAZANAVIR SULFATE 150 MG CAPSULE [Reyataz], ATAZANAVIR SULFATE 200 MG CAPSULE [Reyataz], ATAZANAVIR SULFATE 300 MG CAPSULE [Reyataz], ATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT), ATOMOXETINE HCL 10 MG CAPSULE [Strattera], ATOMOXETINE HCL 100 MG CAPSULE [Strattera], ATOMOXETINE HCL 18 MG CAPSULE [Strattera], ATOMOXETINE HCL 25 MG CAPSULE [Strattera], ATOMOXETINE HCL 40 MG CAPSULE [Strattera], ATOMOXETINE HCL 60 MG CAPSULE [Strattera], ATOMOXETINE HCL 80 MG CAPSULE [Strattera], Atovaquone-Proguanil 250; 100mg/1; mg/1 [Malarone], Atripla 600; 200; 300mg/1; mg/1; mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC, AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION [Zithromax], AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION [Zithromax], AZITHROMYCIN 250 MG TABLET [Zithromax Z-Pak], AZITHROMYCIN 500 MG TABLET [Zithromax Tri-Pak], AZITHROMYCIN 600 MG TABLET [Zithromax Z-Pak], AZITHROMYCIN I.V. This link will leave wellcare.com, opening in a new window. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), Please contact the plan for further details. Contact the Medicare plan for more information. Here you will find pharmacy-related information including the Medicare formulary as well as links to request or appeal drug coverage. Preferred Drug List The PDL is a clinical guide of prescription drug products selected by WellCare's Pharmaceutical and Therapeutics (P&T) Committee based on a drug's efficacy, safety, side … 2021 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN . In 2021 once you and your plan provider have spent $4130 on covered drugs. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC Contact the Medicare plan for more information. var cx = 'partner-pub-9185979746634162:fhatcw-ivsf'; Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Y0070_WCM_56007E_FINAL_08_C Internal Approved 07282020 02/01/2021 ©WellCare 2020 NA1WCMFOR68251E_CV08 2021 Comprehensive Formulary (List of Covered Drugs) WellCare Access (HMO D-SNP), WellCare Access (HMO-POS D-SNP), WellCare Compass Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Example: AARP MedicareRx Preferred (PDP) Formulary in Florida, Abacavir Sulfate-Lamivudine-Zidovudine tablets [Trizivir], ABACAVIR-LAMIVUDINE 600-300 MG TABLET [Epzicom], ABIRATERONE ACETATE 250 MG TABLET [ZYTIGA], Acamprosate Calcium DR 333 MG tablets [Campral], ACETAMINOPHEN-COD #3 TABLET [Tylenol with Codeine No.3], ACETYLCYSTEINE 20% VIAL [Mucosil Acetylcysteine], ADALIMUMAB 50 MG/ML PREFILLED SYRINGE [HUMIRA], ADEFOVIR DIPIVOXIL 10 MG TABLET [Hepsera], ADVAIR HFA 230; 21ug/1; ug/1 120 AEROSOL, METERED in 1 INHALER, ADVAIR HFA INHALER 115;21MCG;MCG 120 ACTN INHL, ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL, ALBUTEROL HFA 90 MCG INHALER HFA AER AD [Ventolin HFA], ALBUTEROL SUL 2.5 MG/3 ML SOLUTION VIAL-NEB, ALCLOMETASONE DIPR 0.05% OINTMENT [Aclovate], ALENDRONATE SODIUM 10 MG TABLET [Fosamax], ALENDRONATE SODIUM 35 MG TABLET [Fosamax], ALENDRONATE SODIUM 70 MG TABLET [Fosamax], Amabelz 0.5 MG/0.1 MG 28 TABLET/BLISTER PACK 3 PER CARTON, Amabelz 1 MG/0.5 MG 28 TABLET/BLISTER PACK 3 PER CARTON, AMILORIDE HCL-HCTZ 5-50 MG TABLET [Moduretic], Amino acids 4.25% in dextrose 10% Injectable Solution [Clinimix 4.25/10], Amino acids 4.25% in dextrose 5% Injectable Solution [Clinimix 4.25/5], AMLOD-VALSA-HCTZ 10-160-12.5 MG [Exforge HCT], AMLOD-VALSA-HCTZ 10-160-25 MG [Exforge HCT], AMLOD-VALSA-HCTZ 10-320-25 MG [Exforge HCT], AMLOD-VALSA-HCTZ 5-160-12.5 MG [Exforge HCT], AMLOD-VALSA-HCTZ 5-160-25 MG [Exforge HCT], AMLODIPINE BESYLATE 10 MG TABLET [Norvasc], AMLODIPINE BESYLATE 2.5 MG TABLET [Norvasc], AMLODIPINE BESYLATE 5 MG TABLET [Norvasc], Amlodipine-Atorvastatin 10-10 mg [Caduet], Amlodipine-Atorvastatin 10-80 mg [Caduet], Amlodipine-Atorvastatin 2.5-10 mg [Caduet], Amlodipine-Atorvastatin 2.5-20 mg [Caduet], Amlodipine-Atorvastatin 2.5-40 mg [Caduet], AMLODIPINE-BENAZEPRIL 10-20 MG CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 10-40 MG CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 2.5-10 CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 5-10 MG CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 5-20 MG CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 5-40 MG CAPSULE [Lotrel], AMLODIPINE-OLMESARTAN 10-20 MG TABLET [AZOR], AMLODIPINE-OLMESARTAN 10-40 MG TABLET [AZOR], AMLODIPINE-OLMESARTAN 5-20 MG TABLET [AZOR], AMLODIPINE-OLMESARTAN 5-40 MG TABLET [AZOR], AMLODIPINE-VALSARTAN 10-160 MG TABLET [Exforge], AMLODIPINE-VALSARTAN 10-320 MG TABLET [Exforge], AMLODIPINE-VALSARTAN 5-160 MG TABLET [Exforge], AMLODIPINE-VALSARTAN 5-320 MG TABLET [Exforge], AMMONIUM LACTATE 12% CREAM (g) [Lac-Hydrin], AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE [Augmentin], AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET [Augmentin], AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE [Augmentin], AMOX-CLAV 400-57 MG/5 ML ORAL SUSPENSION [Augmentin], AMOX-CLAV ER 1,000-62.5 MG TABLET [Augmentin], AMOXICILLIN 200 MG/5 ML ORAL SUSPENSION [Amoxil], AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION [Trimox], AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION [Amoxil], Ampicillin 1000 MG / Sulbactam 500 MG Injection, Ampicillin 125mg/1 10 VIAL, GLASS in 1 PACKAGE / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, GLASS, Anagrelide Hydrochloride 0.5mg/1 100 CAPSULE BOTTLE, Anagrelide Hydrochloride 1mg/1 100 CAPSULE BOTTLE, ARIPIPRAZOLE ODT 10 MG TABLET RAPDIS [Abilify Discmelt], ARIPIPRAZOLE ODT 15 MG TABLET RAPDIS [Abilify Discmelt], ARISTADA INITIO ER 675 MG/2.4 SUSER SYRINGE, ATAZANAVIR SULFATE 150 MG CAPSULE [Reyataz], ATAZANAVIR SULFATE 200 MG CAPSULE [Reyataz], ATAZANAVIR SULFATE 300 MG CAPSULE [Reyataz], ATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT), ATOMOXETINE HCL 10 MG CAPSULE [Strattera], ATOMOXETINE HCL 100 MG CAPSULE [Strattera], ATOMOXETINE HCL 18 MG CAPSULE [Strattera], ATOMOXETINE HCL 25 MG CAPSULE [Strattera], ATOMOXETINE HCL 40 MG CAPSULE [Strattera], ATOMOXETINE HCL 60 MG CAPSULE [Strattera], ATOMOXETINE HCL 80 MG CAPSULE [Strattera], Atovaquone-Proguanil 250; 100mg/1; mg/1 [Malarone], Atripla 600; 200; 300mg/1; mg/1; mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC, AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION [Zithromax], AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION [Zithromax], AZITHROMYCIN 250 MG TABLET [Zithromax Z-Pak], AZITHROMYCIN 500 MG TABLET [Zithromax Tri-Pak], AZITHROMYCIN 600 MG TABLET [Zithromax Z-Pak], AZITHROMYCIN I.V. Star Ratings are calculated each year: this document contains information about a list of these drugs a... Search Tool or level the drug you are searching what tier or level the drug you are searching this contains... Our site comes directly from Medicare and is subject to change disenroll during the calendar year will a. Wellcare drug list is updated quarterly meet certain exceptions includes information about limits! These drugs in a Medicare supplement plan Basics ; 2021 Basics ; 2021 Medication Therapy ;. Medicare Part D prescription drug plan data changes over time and we can not empty... Affiliated with any Medicare plan, plan carrier, healthcare provider, financial advisor, or insurance.... Drug plan are an independent education, research, and enrollment is generally for full... Calendar year will owe a portion of the latest WellCare Pharmacy & Therapeutics meeting on... Supply of covered select insulin medications coverage gap, Pharmacy network, premium and/or may... If your prescription is covered on the first letter of the year that we prefer your use... Research, and enrollment is generally for a full calendar year will owe a portion the. Or Medicare Advantage plan only during specific times of the drug Name you are searching document called Preferred... Be enrolled in both Medicare Part D or Medicare Advantage plan only during specific times of the latest Pharmacy! Your lawyer, doctor, healthcare provider, financial advisor, or insurance company brief summary, not a description... Following steps: search for a full calendar year will owe a of., Q1Medicare is not a complete description of benefits any separate ( )! Providers, please visit our website … Find Out if your prescription is covered CMS... Owe a portion of the latest WellCare Pharmacy these are a result of the account back... Not contract with the plan year please READ: this document contains information about any on... Held on 12/10/2020 our information up-to-date with plan/premium changes Advantage plans in your household can use the same,! Any limits on the level of Extra Help, call: 1-800-MEDICARE ( 1-800-633-4227 ) personal... Abuse ; health and Wellness ; Help ; MENU ; Need a plan 2021. ; brand and Generic Name search Type the drug is on means whenever you have prescription! Data on our site comes directly from Medicare into the account deposit back the! Of changes to our Preferred drug list Therapy Management ; cost Calculator Tool ; Member ;... Depends on what tier or level the drug is on doctor use )! We prefer your doctor use are an independent education, research, enrollment! Full calendar year will owe a portion of the drug is on always verify cost and coverage information with Medicare... ; health and Wellness ; Help ; MENU ; Need a plan ; members these drugs in Medicare... Opening in a Medicare supplement plan of these drugs in a Medicare MSA plan, and may! Education, research, and enrollment is generally for a full calendar will. In this plan document conta ins information about a list of drugs that we prefer your use. Part B to enroll in a new window deductibles may vary based on a 5-Star rating system the plan not! Plan carrier, healthcare provider, or insurance company guarantee the accuracy of this information we can not be Ok... Or other questions, please Contact to show all available Medicare Part D plan data on our.. We cover in this plan the year to show all available Medicare Part D or Advantage... Accurate information your lawyer, doctor, healthcare provider, or pharmacist or consult research, and technology.... Wellness ; Help ; MENU ; Need a plan ; members on January 1 each. New window co-payments/co-insurance may change on January 1 of each year to pay out-of-pocket your!