FAQs
Frequently Asked Questions
Where is WellPower located?
What does WellPower do?
What does managing the pharmacy benefit mean for the consumer?
Are you owned by a drug company, retail pharmacy or other corporation?
Do you offer Consumer Directed Health (CDH) programs?
How is it determined which drugs are included on the WellPower Formulary?
Where is WellPower located?
Corporate Headquarters:
WellPower, Inc.
150 River Rd Ste E3
Montville NJ 07045
Phone: 973-586-6838
Toll Free: 888-822-9355
Fax: 973-331-9220
Email: info@wellpoweronline.com
Click here for directions.
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What does WellPower do?
WellPower is a Pharmacy Program Manager (PPM). Our focus is on managing the drug benefit for our clients and their members. As a PPM, we bring together a wide array of partners to process pharmacy claims and provide clinical support to effectively manage the complexities of the drug benefit.
This WellPower team currently serves more than 32 million members nationwide. Clients include corporations and employers, unions, managed care organizations, health plans, insurance carriers, and third-party administrators, as well as local, state and federal employee programs.
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What does managing the pharmacy benefit mean for the consumer?
When a consumer presents a prescription at a pharmacy, the pharmacist connects with a national computer system to determine eligibility, and perform over 800 clinical safety checks, such as potentially harmful medication interactions and restrictions. The pharmacy transaction is processed within seconds. Typically, once the prescription claim is approved, the pharmacist collects a copay or coinsurance from the patient. The pharmacy is then reimbursed for the remainder of the cost of the prescription, which WellPower collects from the patient's employer or health plan.
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Are you owned by a drug company, retail pharmacy or other corporation?
No. WellPower does not sell drugs and does not own a fulfillment center, which means that we are autonomous in our pursuit of serving our clients because we are free from external ownership or investment by drug manufacturers, drug wholesalers, drug store chains or insurance companies. Additionally, we do not own or operate mail-order fulfillment facilities, specialty pharmacy distribution centers or retail stores.
This autonomy allows us to develop and deliver PPM solutions that are cost-effective, flexible and designed for the sole purpose of meeting specific client needs. The WellPower model and approach leads to better outcomes, lower net costs and higher quality of care for our clients and their members.
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Do you offer Consumer Directed Health (CDH) programs?
Yes. WellPower supports client Consumer Directed Health (CDH) initiatives as part of our commitment to delivering innovative choices. Our consumer directed tools include spending accounts, cash discount cards and a member website.
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How is it determined which drugs are included on the WellPower Formulary?
Unlike an insurance company that claims prescriptions are listed in their formulary solely because they are effective, we very openly tell you why prescriptions are listed on our formulary. We use a two-pronged approach for formulary decision-making.
Clinical Recommendations
We begin with an independent Pharmacy and Therapeutic (P&T) Committee. The P&T Committee reviews and guides clinical recommendations for the therapeutic use of drugs. The P&T Committee advises on the drug selection, placement, clinical guidelines and prior authorization guidelines.
Financial Decisions
Separately, an independent Formulary Committee is responsible for cost decisions. This is the part of the program that most insurance companies never describe to clients. It may be that insurance companies do not consider cost at all in their formulary decisions, but that is doubtful. If it is true, however, that they don’t consider cost, we believe it then shows a lack of responsiveness to client needs. Regardless, for whatever reason(s), it appears that insurance companies are less than forthcoming with regard to their formulary development.
The Formulary Committee abides by P&T recommendations, Therapeutic Designations and Prescribing Guidelines, and positions drugs on the formulary to achieve low net cost and optimize value for our customers.
Formulary decisions are based on efficacy, safety and cost. First and foremost, the formulary is designed to deliver clinically appropriate medication choices. Safety and efficacy are paramount. Secondary to safety and efficacy issues, but still a part of the decision, the formulary is managed to deliver the greatest value, that is, the lowest net cost.
Finally, because of our cost-effective contracting and pricing, we are able to offer a formulary that our members find extremely comprehensive, comparing favorably to all others.
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