Members > FAQs

FAQs

My prescription is for 100 pills, but the pharmacist only gave me 60. Why?

In order to help keep the rising cost of health care in line, most plans are designed to dispense a 30-34 day supply of medication or 100 units, whichever is less. Regarding the 60 dispensed pills described above, the member’s dosage of medication is 2 per day, equaling 60 per month. These limits are designed to prevent stockpiling of drugs and to prevent a member’s usage of surplus drugs that may have experienced a loss in efficacy.

My pharmacist said that my prescription wasn’t covered. Why not?

Please refer to the "Exclusions" portion of the plan document that was included with your ID cards. If the prescription isn’t covered, the member should ask their pharmacist or doctor if there is a similar drug to treat the condition that is on the plan. Remember, even if a drug isn’t covered, the member can still purchase the medication at the drug’s normal price.

My pharmacist said that my prescription needs "Prior Authorization." What does that mean, and how do I get it?

When a drug requires Prior Authorization, it means that more information about the member’s condition is required before the pharmacy can dispense the drug. The member’s physician must contact Caremark’s Prior Authorization center at 888-413-2723 and give them some details about the member’s specific diagnosis. Each member is given a list of drugs that require Prior Authorization with their initial membership materials.

I took my prescription to the drug store and the pharmacist substituted a generic for the brand name drug. What’s the difference?

There really is no difference except for the price. By law, generic drugs are required to meet the same clinical standards as the higher priced brand-name drugs. Most states are what is known as "generic first" states. This means that the pharmacist must substitute the generic form of the drug unless the prescription states otherwise. The member may request the brand-name drug, but with some plans they will be subject to a higher co-pay, usually the difference between the generic co-pay and the actual cost of the drug.

I am using Caremark.com. How long will it take to receive my prescription in the mail?

The member will generally receive their first prescription within 10 to 14 days of placing the order. If the prescriptions do not arrive in that time frame and medication is running low, please ask the member to contact WellNet immediately.

I didn‘t get my prescription card in time to fill a prescription and I paid full price for the drug. What should I do?

If the member receives their card within a few days of purchasing a prescription, they should return to the drug store and ask the pharmacist to re-run the prescription on their card and get reimbursed right there at the pharmacy. If this is against the pharmacy’s policy or if it has been more than two weeks since filling the prescription, the member can submit a claim for reimbursement. The member must send a copy of their prescription receipt (the one that is usually stapled to the bag that the prescription comes in) either via fax or mail to WellNet, along with their plan information: name, ID number, and group number. WellNet will process the claim for the full amount, minus the appropriate co-pay, and a check will be sent directly to the member from Caremark.

I lost my ID card. What do I do?

Please call WellNet as soon as possible. We will order and mail the replacement card(s) directly to the group administrator in about 10 to 14 days. In the meantime, the member can use their group number and ID number to purchase their prescriptions.

Who do I call if I have any problems or questions regarding the plan?

Members can speak with WellNet Customer Service representatives during normal business hours of 9am to 5pm (EST), Monday through Friday. If the member calls before or after hours, they can leave a message on voice mail. If they have a question regarding the status of their mail order, they can call Caremark Member Services at 800-966-5772.