Pharmacy

Pharmacy Overview

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.  

Prescription Fulfillment

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

  1. Check the formulary to see if prior authorization is required for a medication.
  2. 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.
  3. 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)
  4. 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)

Search Covered Drugs

> Medicaid
> Medicare Advantage


Community Mental Health Center Providers Only

Prior Authorization requirements for Behavioral Health Medications for CMHC providers in NH:

Contact Us

Medicaid Services:
877-957-1300 option 3

Medicare Services:
866-808-3833

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