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Know if you have pharmacy coverage

Prescription drugs are an important part of your health care coverage. If you have prescription drug coverage through Wellmark, this information can help you and your health care provider get the most from your prescription drug coverage.

You can find out if you have prescription drug coverage through Wellmark in one of three ways:

  • Log in and view your pharmacy coverage in myWellmark Secure Site®.
  • Search for your coverage documents using your Wellmark ID number.
  • Call the number on your Wellmark member ID card for assistance.

View your pharmacy coverage Secure Site

Locate an in-network pharmacy

Find your nearest pharmacy by using the CVS Caremark Pharmacy locator tool. Wellmark contracts with CVS Caremark, an independent company that administers your pharmacy benefits on behalf of Wellmark, to provide access to a national network of community pharmacies.

Find a Pharmacy External Site

Drug lists

Also known as a formulary, your drug list will tell you if a drug is covered under your plan, whether it needs special approval to be filled, coverage limits and if a generic option is available — which could save you money.

But first, you will need to know the name of your plan's drug list. Find out in one of these ways:

View your drug list:

Important to know about drug lists:

  • Your health plan’s drug list is regularly updated as generic drugs become available and changes take place in the pharmaceuticals market, so it’s good to check it regularly. For the most up-to-date information, log in to myWellmark Secure Site or call the number on your ID card.
  • Your plan’s drug list will also show if it’s a specialty medication, if it has any prior authorizations, quantity or age limits, and what tier Glossary popover your drug falls on.

Find prior authorizations and quantity limits

For certain prescription drugs, additional coverage requirements or limits will apply. Prior authorizations encourage safe, cost-effective medication use by allowing coverage when certain conditions are met. myWellmark Secure Site will give you all the information you need to know to determine if your prescription is subject to prior authorizations and quantity limits.

Important to know about prior authorizations and quantity limits:

  • If a drug isn’t on your formulary, it can’t be approved through the authorization process, and you should work with your doctor and have them use the Wellmark Drug List to find an appropriate alternate, if available.
  • If your doctor says there isn’t another option, they can request an exception using the Global Prior Authorization Form External Link. Obtaining the approval in advance will help to prevent delays at the pharmacy.
  • If your drug is approved, it can be filled at any in-network pharmacy according to your plan’s benefit.
  • If your pharmacy benefit plan changes, a new prior authorization may be required and additional quantity limits may apply.

In addition, coverage for certain drugs is limited to specific quantities per month, benefit year, or lifetime. The purpose of these quantity and dispensing limits is to improve the quality of pharmaceutical care to obtain appropriate outcomes and to address inappropriate utilization at the time of dispensing to minimize health risks and reduce overall costs. Requests for the drug to be filled over quantity limitations are not covered unless there is authorization criteria in place to request additional quantities from your health care provider and approval is granted.

Federal regulations limit the quantity that may be dispensed for certain medications. If your prescription is so regulated, it may not be available in the amount prescribed by your doctor. Your benefits certificate, coverage manual, or policy has specific information about your plan's authorization requirements.

Mail order pharmacy service

Depending on your pharmacy benefits, you may be able to save time and money by using mail order pharmacy for the prescriptions you take regularly. With mail order, filling your prescriptions is convenient, secure and confidential. The quickest way to get started is to log in to myWellmark, navigate to the Coverage page, click the Prescription tab, then Prescription Resources and Start Mail-Order Service. There you will be directed to Wellmark’s preferred pharmacy vendor to complete registration.

Note: For specialty drugs, use one of our preferred vendors.

Start mail order pharmacy Secure Site

Don't have a myWellmark account? No problem. Create a Caremark.com External Site account using your Wellmark ID and personal information to fill prescriptions and manage your order pharmacy account.

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