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Provider : Pharmacy Services

The retail outpatient pharmacy services are a non-covered Plan benefit. Retail pharmacy services are covered by the State Medicaid program on a fee-for-service basis.

Harmony Health Plan does provide its members pharmacy services for injectable drugs and infusion products administered in a provider’s office. Injectable products and all infusion drug requests require a Drug Evaluation Review and are supplied by a specialty vendor arranged by the Plan. Specialty drugs require a DER and are not available through the retail pharmacy network.

Injectable/Infusion Drug Evaluation Review Request Form

Enteral Nutrition Supplement Form

Medical Injectibles Prior Authoization Requirements:

Harmony Health Plan (WellCare) continuously strives to reduce barriers to care and therapies. In reviewing our medical injectible prior authorization requirements, WellCare identified an opportunity to consolidate and align the list of required codes. We have combined our Medical and Pharmacy injectible prior authorization code lists into one consistent list, and aligned that list with current industry practice.

No Authorization Required Medical Injectible List- Effective December 7, 2010

For detailed information about pharmacy services, refer to the pharmacy section of the Provider Manual.

The WellCare Pharmacy Department telephone number is 1 (877) 647-7473.