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. Launched in 2019, our Student Formulary offers students more than 40 drug and device 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.

*The Wellfleet Rx Student Formulary is proprietary to Wellfleet Group, LLC and protected by applicable copyright, trademark, and trade secrets laws. Information contained therein may not be published, distributed, or reproduced, in part or whole, without express written consent of Wellfleet Group, LLC.

 

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 Connecticut, Louisiana, and Texas require your plan to cover medications at the same benefit level until your plan year ends. This means that if a medication covered under your formulary at the start of your plan year is taken off the formulary, is changed to a different cost-share tier, or has new utilization management requirements, these changes will not go into effect until the next plan year.

Student Formulary Changes – Effective July 2023**

2023 ACA Drug List – Effective July 2023

July 2023 Student Formulary: Refer to this formulary unless your school is in California, Colorado, Connecticut, or Texas, or listed as a separate school-specific formulary in the below options.

**Unless otherwise prohibited by state law

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July 2023 Student Formulary – Wellfleet Global Plans: Refer to this formulary if your plan is a Wellfleet Global plan, even if it is located in one of the states listed below

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State Specific Formularies – Effective July 2023:

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School Specific Formularies – Effective July 2023: 

There are currently no upcoming formulary changes. Please see “Current Wellfleet Rx Formularies“, above, for the most up-to-date information.

January 2023

Student Formulary Changes – Effective January 2023**

2023 ACA Drug List – Effective January 2023

January 2023 Student Formulary: Refer to this formulary unless your school is in California, Colorado, Connecticut, or Texas, or listed as a separate school-specific formulary in the below options.

**Unless otherwise prohibited by state law

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State Specific Formularies – Effective January 2023:

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School Specific Formularies – Effective January 2023: 

July 2022

Student Formulary Changes – Effective July 2022

2022 ACA Drug List – Effective July 2022

July 2022 Student Formulary: Refer to this formulary unless your school is in California or listed as a separate formulary in the drop-down options.

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State Specific Formularies – Effective July 2022:

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School Specific Formularies – Effective July 2022:

January 2022

Student Formulary Changes – Effective January 2022

2022 ACA Drug List – Effective January 2022

January 2022 Student Formulary: Refer to this formulary unless your school is in California or listed as a separate January 2022 formulary below:

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July 2021

Student Formulary Changes – Effective July 2021

2021 ACA Drug List – Effective July 2021

July 2021 Student Formulary: Refer to this formulary unless your school is in California or listed as a separate July 2021 formulary below:

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January 2021

Student Formulary Changes – Effective January 2021

January 2021 Student Formulary: Refer to this formulary unless your school is in California or listed as a separate January 2021 formulary below:

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July 2020

2020 ACA Drug List – Effective July 2020

Student Formulary Changes – Effective July 2020

July 2020 Student Formulary: Refer to this formulary unless your school is in California or listed as a separate July 2020 formulary below:

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January 2020

January 2020 Student Formulary: Refer to this formulary unless your school is in California, Massachusetts, or listed as a separate January 2020 formulary below:

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 available here:

For Wellfleet Rx Prior Authorization Guidelines, click here.

40+ free drug & device 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 Drugs” 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 Drugs 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 Drugs” 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.

Promoting opioid safety

Wellfleet Rx promotes safety and appropriateness before opioids are dispensed through 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. See applicable Student Formulary for more information.

The Wellfleet Rx Student Formulary also includes $0 coverage on some forms of the opioid rescue medication, naloxone. Many states have laws in place that allow the general public to obtain this product at their pharmacy without a prescription from their healthcare provider. Please talk to your healthcare provider or pharmacist for more information. 

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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.

Products, documents and materials provided by Wellfleet including the material contained therein, are proprietary to Wellfleet Group, LLC and protected by applicable copyright or trade secrets laws. Information contained within may not be published, distributed, or reproduced, in part or whole, without express written consent of Wellfleet Group, LLC.