WellCare Health Plans, Inc.

‘Ohana Health Plans

Easy Choice Health Plan

RXBIN: 004336

RXPCN: MEDDADV

RXGRP: 788257

WellCare is an existing client with CVS Caremark®. As a reminder, CMS guidelines prohibit Medicare-contracted Providers from collecting cost-share for Medicare-covered services from Qualified Medicare Beneficiaries (QMBs), including some WellCare members.

QMBs have no legal obligation to make further payment to a Provider for Part B-covered medications/supplies. Balances should be billed to Medicaid as the secondary payer. Per CMS guidelines, if a full or partial balance remains after billing Medicaid, or if the Provider is unable to bill Medicaid, they are still required to dispense the medication/supply without balance billing the beneficiary. Providers who inappropriately bill QMB patients may be subject to sanctions as established in Section 1902(n)(3)(C) of the Social Security Act.