See Which Medications are Covered by Well Sense*
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. Learn which drugs 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 (formulary) may change at any time.