Ask your coverage questions weekdays from 8 a.m. to 5 p.m. CT.
To find out if the prescription medications you take are subject to Prior Authorization or Step Therapy restrictions, type the name of the drug in the Search box on the online formulary page box above. You may also review the documents below that explain our prior authorization and step therapy restrictions. If your prescription does require Prior Authorization or Step Therapy, please download and have your prescribing doctor complete a Coverage Determination Request Form.
If you have requested a Coverage Determination or Redetermination (Appeal) and you would like to check the status, please call us at 1-800-688-1604 (TTY: 1-800-716-3231) 24 hours a day, seven days a week
You may also find out if a drug you take is subject to additional requirements or Quantity Limit restrictions by reviewing the WPS MedicareRx Plan formulary or inquire by phone by calling Customer Service.
The WPS MedicareRx Plan (PDP) conducts drug utilization reviews for all our customers to make sure that they are getting safe and appropriate care. These reviews are especially important for customers who have more than one doctor who prescribes their medications. Drug utilization reviews are conducted each time you fill a prescription, and on a regular basis by reviewing our records. During these reviews, we look for medication problems such as:
If we identify a medication problem during our drug utilization review, we will work with your doctor to correct the problem.
A formulary is a list of the brand and generic drugs covered by your plan. WPS MedicareRx Plan covers both brand drugs and generic drugs. Generic equivalents have the same active ingredient(s) as a brand drug. Generic drugs usually cost less than brand drugs and are rated by the Food and Drug Administration (FDA) to be as safe and as effective as brand drugs.
The WPS MedicareRx Plan (PDP) formulary includes more than 3,000 covered medications, making it one of the nation's largest formularies.
We may periodically add or remove a drug, make changes to coverage rules on certain drugs, or change how much you pay for a drug. If we make any formulary change that limits your ability to fill prescriptions, we will notify you at least 30 days before the change is made. Note that if the Food and Drug Administration finds that a drug on the formulary is unsafe or if the drug's manufacturer removes the drug from the market, we immediately remove the drug from our formulary and then notify you of the change.
Some drugs may be covered under Medicare Part B or Medicare Part D depending upon the circumstances. Information may need to be submitted describing the use and setting of the receipt of the drug to make the determination.
The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For full information on WPS MedicareRx Plan benefits, call our Customer Service.
You may be able to get a temporary supply if your drug is not on the Drug List or is restricted. Here are things you can do:
Under certain circumstances, the plan can offer a temporary supply of a drug to you when your drug is not on the Drug List or when it is restricted in some way. Doing this gives you time to talk with your provider about the change in coverage and figure out what to do.
To ask for a temporary supply, call Customer Service 1-800-688-1604 (TTY: 1-800-716-3231), 24 hours a day, seven days a week.
During the time when you are getting a temporary supply of a drug, you should talk with your provider to decide what to do when your temporary supply runs out. You can either switch to a different drug covered by the plan or ask the plan to make an exception for you and cover your current drug.