In order for WellSense to pay for a medication, it must be covered by our plan.
- Search our List of Covered Drugs* for a list of prescription and over-the-counter drugs covered by our plan.
- If the List of Covered Drugs shows that there are limits on your medications, you can learn more about them in the WellSense Medication Guide Book.
What if my prescription is not covered?
Call Member Services at 1-877-957-1300 and give them the name of the drug. They'll tell you if there are any restrictions on that drug, and what to do next.
Reasons a prescription drug may not be covered could include:
- If a brand-name drug has a generic version, your doctor must prescribe the generic drug (drugs with the same ingredient as a brand-name drug, but with a different name) when available.
- If a drug might not be safe or effective at a certain dose or strength. In order to ensure that you get a safe and effective dose of a prescription drug, we may set limits on is quantity and dose strength.
- If a drug is newly approved by the FDA, your doctor may need to get prior authorization from us before prescribing it.
- If a drug should only be used for certain medical conditions, we may ask your doctor to provide additional medical information before we cover a non-preferred drug.
- If you have Medicare Part D coverage, only drugs that are excluded under the Medicare Part D program will be covered by your pharmacy benefit. All other drugs will need to be obtained through your Medicare Part D plan. Not sure if you have Medicare Part D? Call 1-800-Medicare (1-800-633-4227).
Request an exception
To request an exception, first talk with your doctor about requesting prior approval from us. Your doctor will need to request a prior authorization explaining why you need the medication.
After we receive the statement, we will send your doctor a decision on your exception request. If we need more information on your doctor's request, it could take longer to get a decision.
Questions? Call Member Services at 1-877-957-1300.
*Our prescription drug plan and List of Covered Drugs may change at any time.