WellCare has put together a network of over 60,000 pharmacies. You can take your prescription to any one of these network pharmacies and get your medication filled. Typically, most members get their prescriptions filled at one of our network pharmacies. On occasion, members may have to use a pharmacy that is not enrolled in WellCare’s network to get their prescriptions filled due to an emergency or other unforeseen circumstance.
WellCare will only cover drugs filled at an out-of-network pharmacy in limited circumstances when a network pharmacy is not available. These include illness and if you are traveling outside of WellCare’s service area where there is no network pharmacy. For example, you go on vacation and get sick while on vacation. You receive a prescription and get it filled at the local pharmacy. Unfortunately, you have to pay full cost of the medication because the pharmacy is not a WellCare network pharmacy. When you return from vacation, you may submit a Direct Member Reimbursement form for possible reimbursement. In addition, you may be required to pay the difference between what you would pay for a prescription filled at an in-network pharmacy and what the out-of-network pharmacy charged for your prescriptions.
You can request a Direct Member Reimbursement form by calling Customer Service or you can download a copy of the form and instructions on how to complete it. Please make sure to complete the form (including your signature) and attach all necessary pharmacy receipts. WellCare will accept a pharmacy printout (in lieu of the pharmacy receipts), but the medication that you are requesting reimbursement for must be notated on the printout. Once you have completed the form, please mail it along with a copy of your prescription receipt(s) to the following address: WellCare, Reimbursement Department, P.O. Box 31577, Tampa, FL 33631-3577.
Reimbursement usually takes four to six weeks from the date you mail in the Direct Member Reimbursement Form. Be sure that your form is completed and all necessary information is attached. Otherwise, your request may be delayed. Formulary guidelines will apply to all reimbursement requests.
If you have any questions, please contact Customer Service at 1-866-207-6301 (TTY/TDD users call 1-866-239-6265) Monday-Sunday 8am-2am Eastern Time.