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Wellcare Benefit 2024 - Updated

Date: 04/25/24

Benefit Updates for 2024

MAPD: HMO, C-SNP, D-SNP, PPO

Preferred Pharmacy Network:

Our Medicare Advantage* and Prescription Drug Plans offer a robust, dependable pharmacy network with over 60,000 pharmacies in network — many offering preferred cost-sharing!* A member’s cost-share may be lower when prescriptions are filled through one of our preferred retail pharmacies or our preferred mail-order pharmacy, Express Scripts.® However, members may have prescriptions filled at any network pharmacy. Walgreens,® CVS,® grocers, and select independents pharmacies remain withinthe preferred 2024 pharmacy network. Amazon® is no longer a preferred pharmacy but remains in the pharmacy network.

Remember, some retail pharmacies offer both retail  and home delivery options. If a member fills a prescription with a retail pharmacy that also offers home delivery, the retail cost share will apply, and pharmacies may charge a delivery fee.

Please utilize the Find a Provider tool to find an in-network pharmacy. This will also allow you to find an in-network pharmacy’s network status (standard vs preferred and if 90/100-day fill is offered).

*Preferred pharmacy network not available for Wellcare D-SNPs.

Formulary Updates

Beginning January 1, 2024,MAPD members will be able to receive up to a 100-day supply of qualifyingmedications with each fill fornon-specialty medications atall in-network pharmacies.

The formulary GLP-1 agonistsBydureon Bcise,® Mounjaro,®Ozempic,® Rybelsus,® andTrulicity® will require a priorauthorization (PA) to confirmmedically-appropriate usefor the treatment of type 2diabetes (not covered forweight loss, pre-diabetes, type 1 diabetes, or heartdisease prevention). The PA applies to all new and existingusers of GLP-1 agonists.

Effective January 1, 2024, Express Scripts Pharmacy® replaced CVS Caremark® as our preferred mail order provider. CVS Caremark Mail Order® is out-of-network in 2024.

For existing mail order users:

  • Most open prescription refills were automatically transferred to Express Scripts.® Refills of controlled drugs were NOT automatically transferred. Members will need to request new prescriptions from their providers.
  • Member  s who need new mail-order prescriptions may either: