As part of our ongoing efforts to provide members with sustainable, affordable health plans, we’ve determined that it’s necessary to make adjustments to the WellCare formulary.

WellCare is an existing plan sponsor with CVS Caremark®. Effective January 1, 2018, member copays will change.

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.

WellCare of Florida (Medicaid) Florida Medicaid Staywell/Staywell Kids Effective January 1, 2016, CVS/caremark began to administer the prescription benefits for WellCare of Florida, a Care Management Organization, in the Florida Medicaid Program. WellCare of Florida members will be transitioned to a network with CVS/caremark that continues to meet member access requirements, but may offer fewer Providers. Providers that are out of network are eligible for a 90-day continuity of care period where claims are payable to allow time for members to transfer their prescriptions to an in-network pharmacy. The continuity of care period ends on March 31, 2016. The pharmacy claims processing information to CVS/caremark for WellCare of Florida (Staywell/Staywell Kids) is noted below. RXBIN: 004336 RXPCN: MCAIDADV RXGRP: RX8888 & RX8887