In order for WellSense to pay for a medication, it must be covered by our plan.

Medications covered

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.