Access information and resources necessary for prescribing medications to Well Sense members.
Check Drug Coverage
Before prescribing a prescription or over-the-counter medication, check the Formulary to make sure it’s covered by our plan.
Members are able to fill prescriptions using the following:
- Retail pharmacy: Find one by using the Find a Pharmacy tool.
- Specialty pharmacy: Certain injectables and biotech drugs must be obtained through our specialty pharmacy network. Our preferred specialty pharmacies are Cornerstone Health Solutions and Accredo. Learn more about our Specialty Pharmacy Program.
- Mail order pharmacy: Members can get a 3-month supply of maintenance drugs delivered to their home and save money by contacting our mail order pharmacy, Cornerstone Health Solutions, at 844-319-7588.
Prior Authorization and Clinical Guidelines
- Check the formulary to see if prior authorization is required for a medication.
- If you believe that it is medically necessary for a member to take a medication that is not covered by our pharmacy program: You may submit a coverage review request online through one of these ePA portals: Surescripts, CoverMyMeds, or ExpressPAth.
- If you do not have access to an ePA system, you can contact 877-417-1839 to submit your request or submit your request by paper with the:
Medication PA form (for Medicaid)
Medication PA form (for Medicare Advantage)
- Remember: Always view our Pharmacy Policies prior to submitting your coverage review request.
Medical Benefit Drug Review for select drugs
Here is our current prior authorization (coverage review) process for eleven select Medical Drug policies:
5. Check the Well Sense Health Plan Policy Topics and Covered HCPCS Drug Code List to see if prior authorization (or coverage review) is required for a medication, and associated J code, you are requesting.
6. If you believe that it is medically necessary for a member to take a medication that is not covered by our medical benefit program: You may submit a coverage review request via Fax by submitting the appropriate form below to (866) 539-7185 or by phone by contacting 877-417-1839.
7. Always view our Pharmacy Policies prior to submitting your coverage review request.
Medical Benefit Drug Review PA Forms (for select drugs)
- Asthma Monoclonal Antibodies Medical PA form
- Bevacizumab Products Medical PA form
- Compliment Inhibitors Medical PA form
- Erythropoiesis Stimulating Agents Medical PA form
- Filgrastim Products Medical PA form
- GnRH Medical PA form
- Inflammatory Conditions Medical PA forms
- Infliximab Products Medical PA form
- Pegfilgrastim Products Medical PA form
- Rituximab Products Medical PA form
- Trastuzumab Products Medical PA form