Formularies - Wellfleet Rx

STUDENT FORMULARY

The industry's only student formulary

When we introduced our own pharmacy solution, our goal was to move beyond the cookie-cutter approach to pharmacy care and build a solution for the college health space that aligned with students’ budgets, schedules, and lives.

With the introduction of the Wellfleet Rx Student Formulary, we’ve accomplished our goal. New for the 2019-2020 school year, our Student Formulary offers students more than 40 generic options at $0.00 copay, incentives to steer utilization away from high-cost generics, and controls to prevent the abuse and misuse of opioids.

Learn more about this innovative new solution — exclusive to Wellfleet Student health plans.

Current formulary information

Wondering what a formulary is? Don’t worry, we’re here to help. A formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. It may also be referred to as a drug list. Your formulary provides detailed information on what drugs are covered under your pharmacy benefits, which drugs are excluded from coverage, and much more. Please find a link to your formulary to the right and, as always, contact us with any questions regarding this important document.

Formulary updates

In an effort to support continued access to safe, clinically effective, and affordable prescription drug benefits, Wellfleet Rx makes adjustments to its formulary when appropriate. Changes that may impact your copay or coverage are targeted for January and July of each year*, unless there is compelling clinical evidence, economic considerations, or other market factors that necessitate more frequent changes. Members will be notified by letter prior to negative changes going into effect.

*State laws in Texas and Louisiana require your plan to cover your medications at your current benefit level until your plan renews. This means that if your medication is taken off the drug list, is moved to a higher cost-share tier or needs approval, these changes will not go into effect until your renewal date.

Current Formularies

Student Formulary Changes Effective July 2020

ISO National Preferred Formulary Changes Effective July 2020

July 2020 Student Formulary: Refer to this formulary unless your school is in California or listed as a separate formulary in the drop-down options.

July 2020 Student Formulary for New York University Students

July 2020 Student Formulary for University of California Berkeley Students

J uly 2020 Student Formulary for Schools in California (excluding UC Berkeley)

July 2020 Student Formulary for Schools in Massachusetts with BIN 012882 on ID Cards

2020 ACA Drug List – effective 7/1/2020

April 2020 National Preferred Formulary for ISO Plans with Retail Pharmacy Benefits

Upcoming Formulary Changes

Next planned updates will be posted October 2020.

Older Formulary Versions

January 2020 Student Formulary: Refer to this formulary unless your school is in California or listed as a separate formulary in the drop-down options.

January 2020 Student Formulary for New York University Students

January 2020 Student Formulary for University of California Berkeley Students

January 2020 Student Formulary for Schools in California (excluding UC Berkeley)

January 2020 Student Formulary for Schools in Massachusetts

Prior Authorization

For details on the specific criteria that will be applied when making a determination on a prior authorization request, refer to the Prior Authorization Guidelines.

40+ free generic options

In addition to the $0 medications available under ACA preventive requirements, the Wellfleet Rx Student Formulary offers 40+ antibiotic, dermatology, and behavioral health medications at no copay.* Refer to the “Zero Cost Generics” section of the Student Formulary for the full list of medications covered under this program.

We encourage you to share this list with your prescriber if you are receiving a medication in one of the categories featured to determine if a zero cost option may be appropriate for your treatment.

*Zero Cost Generics program may vary by school or may not be available to certain schools. See applicable Student Formulary for more details. If there is no “Zero Cost Generics” section included in the Student Formulary applicable to your plan, this program is unavailable.

Incentives to steer away from high-cost generic drugs

Preferred generics are available under the tier 1 of the Wellfleet Rx Student Formulary. Compared to their higher cost generic counterparts, the preferred generics have been reviewed for similar efficacy and clinical indications and similar side effect profiles.

To help allow students and their providers to make informed decisions and drive them toward preferred generics, some high cost generics may be placed in a higher formulary tier and be associated with higher copays.

Students are encouraged to discuss preferred generic alternatives with their providers when prescribed a non-preferred generic. Pharmacies will receive point-of-sale messaging and students will receive letters when non-preferred generics are prescribed to provide education on preferred, lower cost alternatives.

Preventing opioid abuse and misuse

The STOP program from Wellfleet Rx promotes safety and appropriateness before opioids are dispensed through improved drug utilization controls.

The Wellfleet Rx Student Formulary includes utilization management requirements and limitations on opioids to prevent excessive opioid dispensing and unnecessary long-term opioid use. Formulary controls include days supply limitations, prior authorizations on refills, and cumulative dose threshold reviews.

Students

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Wellfleet is the marketing name used to refer to the insurance and administrative operations of Wellfleet Insurance Company, Wellfleet New York Insurance Company, and Wellfleet Group, LLC. All insurance products are administered or managed by Wellfleet Group, LLC. Product availability is based upon business and/or regulatory approval and may differ among companies.