Pharmacy Information and Resources

Access information and resources necessary for prescribing medications to WellSense members.

Provider_Child_GI1213797507_Resize

Check Drug Coverage

Before prescribing a prescription or over-the-counter medication, check to make sure it's covered by the member's plan. Search our current formularies.


Prescription Fulfillment

Members are able to fill prescriptions through a:

  • Retail pharmacy: Select the member's plan from the Find a Pharmacy drop down menu on this page. Members can fill prescriptions at any pharmacy in the network.
  • Specialty pharmacy: Certain injectables and biotech drugs must be obtained through our specialty pharmacy network. Cornerstone Health Solutions is our preferred specialty pharmacy, but members may use any specialty pharmacy in our network. For more information, call Cornerstone Health Solutions at 1-844-319-7588.
  • Mail order pharmacy: Members can get a 3-month supply and save money on maintenance drugs by contacting our mail order pharmacy, Cornerstone Health Solutions, at 1-844-319-7588.

Prior Authorization and Clinical Guidelines

Here is our current prior authorization (coverage review) process:

  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 877-417-1822 for MassHealth members or 877-417-0528 for Qualified Health Plan members. Or, you can submit the appropriate Standard Medication Prior Authorization Form:
    MassHealth
    Qualified Health Plan
  4. As always, please view our Pharmacy Policies before submitting your coverage review requests.

Medical Benefit Drug Review for select drugs

Here is our current prior authorization (coverage review) process for six select Medical Drug policies:

  1.  Check the Massachusetts Medicaid and Qualified Health Plan Policy Topics and Covered HCPCS Drug Code List to see if a prior authorization is required for the medication, and associated J-code, you are requesting.
  2.  If you believe 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
    • Phone by contacting 877-417-1822 for MassHealth members or 877-417-0528 for Qualified Health Plan members.
  3. As always, please view our Medical Drug Policies before submitting your coverage review requests.
 
Medical Benefit Drug Review Prior Authorization Forms (for select drugs)

Asthma 

Compliment Inhibitors

Erythropoiesis Stimulating Agents

Filgrastim

Infliximab

Rituximab

Massachusetts Medicaid and Qualified Health Plan Policy Topics and Covered HCPCS Drug Code List

Pharmacy Programs

We use a number of pharmacy programs to promote the safe and appropriate use of prescription drugs. All drugs that belong to a program have clinical guidelines (like current health condition) that must be met before the Plan will cover it. Drugs that belong to a pharmacy program are indicated on the WellSense Formulary.

View our Pharmacy Programs.