- To Report Fraud, Waste and Abuse
- Call ECHP's Hotline: 866 678-8355
24 Hr Nurse Advice Hotline (800) 581-9952
2017 Benefit Year:
Easy Choice Best Plan: (H5087-005)
Drug Formulary Search a Drug
Easy Choice Best Plan: (H5087-016)Drug Formulary Search a Drug
English [PDF, 4.3MB] Chinese Korean
Spanish [PDF, 2.3MB] Vietnamese
Easy Choice Freedom Plan: (H5087-001)Drug Formulary Search a Drug
Easy Choice Plus Plan: (H5087-002, H5087-017)Drug Formulary Search a Drug
What is a formulary?
A formulary is a list of covered drugs believed to be a necessary part of a quality treatment program. Easy Choice works with a team of health care providers to create this list and to make sure we cover a full range of medications that our members need. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at an Easy Choice network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.
Both the formulary search tool and downloadable formulary will provide you with drug details that may help lower your drug costs. If you have questions about our formulary or if your medication is not listed, please contact us.
What is a comprehensive formulary? A comprehensive formulary includes the entire list of drugs covered by Easy Choice and is posted for you to review.
Can the formulary change? The formulary may change during the year. To get updated information about the drugs covered by Easy Choice, please see the most recently posted formulary or call Customer Service.
What are generic drugs? Easy Choice covers both brand-name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand-name drug. Generic drugs usually cost less than brand-name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand-name drugs.
How can I save money with Easy Choice?
- Use Easy choice network pharmacies to fill your prescriptions. Member will pay our low, negotiated network rates for all drugs on our formulary. Check your Pharmacy Directory or use the online pharmacy search tool to locate a network pharmacy near you.
- Fill your prescription our Network Mail Service Pharmacy that offers preferred cost-sharing* - Easy Choice plans offer lower co-pays for Preferred Generic (Tier 1) drugs when you have them filled through CVS/Caremark mail service pharmacy, which offers preferred cost-sharing. Refer to our online pharmacy search tool or call Customer Service for more information.
- Switch to our preferred generic drugs - Ask your doctor if generics may be right for you. Generic medications are FDA-approved and have the same active ingredients, indicators, dosage, safety, and strength as the brand-name medication and generally costs less.
Are there any restrictions on my coverage?
Easy Choice requires you or your physician to obtain prior authorization from the plan for certain drugs. This means you will need approval from Easy Choice before you fill your prescriptions. If you do not get approval, Easy Choice may not cover the drug. Drugs that require prior authorization are noted with "PA" on both the downloadable formulary and search tool.
2017 Prior Authorization Essential Formulary
English [PDF, 3.27MB]
2017 Prior Authoriatoin Expanded Formulary
English [PDF, 3.43MB]
In some cases, Easy Choice requires you first try specific drugs to treat your medical condition before we will cover another drug for that condition. Drugs that require step therapy are noted with "ST" on both the downloadable formulary and search tool. View Easy Choice´s: Transition Policy in case your medication is not covered.
2017 Step Therapy Essential
2017 Step Therapy Expanded
For certain drugs, Easy Choice limits the "per fill" drug amount Easy Choice will cover. Drugs with quantity limits are noted with "QL" on both the downloadable formulary and search tool.
Direct Member Reimbursement (DMR)
- Direct Member Reimbursement (DMR) is a process where a member can request for reimbursement (refund) of amounts they may have paid out-of-pocket for medications that were not processed through the pharmacy.
- What to include with each Direct Member Reimbursement request:
- A completed, signed Direct Member Reimbursement form
- Detailed prescription receipt or pharmacy printout. The following information must be present on the prescription receipt or pharmacy printout – patient name, pharmacy name, physician name, drug name, drug strength, quantity, NDC, days’ supply and the patient paid amount. Handwritten receipts will not be accepted.
- If any of the above information is missing, the Direct Member Reimbursement may be denied. The member can resubmit the Direct Member Reimbursement form with the missing/incomplete information (if needed).
To submit a claim for direct member reimbursement, you may access and print the
Direct Member Reimbursement form[PDF, 284KB]
Please mail prescription label receipt(s), cash register receipts and the completed form to:
WellCare Reimbursement Department
PO Box 31577
Tampa, FL 33631-3577
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