In order for Well Sense to pay for a medication, it must be covered by our plan.
Medications Covered by Well Sense
- Search our Drug List* for a list of prescription and over-the-counter drugs covered by our plan.
- If the Drug List shows that there are limits on your medications, you can learn more about them in the Well Sense Medication Guide Book.
There are some prescription drugs that must meet certain guidelines before we will cover them. For example:
- Sometimes we require your doctor to prescribe generic drugs (drugs with the same ingredients as a brand name drug, but with a different name) when available
- In order to ensure that you get a safe and effective dose of a prescription drug, we may set limits on its quantity and dose strength
- Your doctor may need to get prior approval from us before prescribing a newly marketed drug
- We may ask that you try a preferred drug (one that has been proven to work) before we cover a non-preferred drug
- Certain drugs for complex conditions can only be filled at a specialty pharmacy. Search the drug list to see if a drug must be filled at a specialty pharmacy.
- If you have Medicare Part D coverage, only drugs that are excluded under the Medicare Part D program will be covered by your Well Sense 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).
For more information on when these rules apply, see pharmacy programs.
Questions? Call Well Sense Member Services at 877-957-1300, Monday-Wednesday, 8 a.m. to 8 p.m., Thursday-Friday 8:00 a.m. to 6:00 p.m.
*Our prescription drug plan and drug list may change at any time.