FAQs
Frequently Asked Questions
General Questions
Pharmacy Questions
Pharmacy Benefit Questions
Technical Questions
General Questions
Who is WellPower?
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.
The prescription benefit industry is a seemingly gargantuan and wasteful structure that benefits a narrow slice of its participants. The industry is characterized by multiple layers of middlemen, impenetrable contracts, hidden spreads and charges, and words and phrases that mean other than that of their everyday definitions.
WellPower has peeled back these layers, contracted with industry leaders in their various functions, removed excess costs and has created a seamless interface, all with the sole objective of delivering easy to understand, affordable prescription plans to its clients. When we act as an organization’s prescription program manager (PPM), we not only deliver savings of 20% to 40%, but we do so with little to no disruption to employees or an organization’s day-to-day operations.
Moreover, 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.
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Who do I contact if I have questions?
Refer to the Help Desk section in the menu bar for contact information.
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Pharmacy Questions
How do I find a participating pharmacy?
You can find a participating pharmacy by clicking on the Pharmacy Locator link located in the menu bar and entering your criteria. Pharmacy Locator was designed to help you identify pharmacies that participate in the network that serves your pharmacy benefit plan. At a minimum, you will need to enter city and state or zip, and select the distance you are willing to travel to a participating pharmacy. Pharmacy Locator will display up to 20 participating pharmacies within the specified travel radius.
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Where can I get my prescription filled for the lowest cost?
The pharmacies that participate in the network have agreed, typically through contractual arrangements, to provide covered pharmacy-related products and services for a defined reimbursement formula. Therefore, your cost (or copayment amount) should be the same at all participating pharmacies.
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Can I get my medication at a non-participating pharmacy?
In most instances, you will not need to visit a non-participating pharmacy. Although your pharmacy network may not include all pharmacies, we have more than 64,000 pharmacies nationwide, which ensures access to a convenient participating pharmacy. When you choose to purchase a covered medication at a non-participating pharmacy, you may be required to pay a higher copayment amount or 100% of the cost. Then, if your plan allows for direct member reimbursement, you may submit a claim to WellPower. To find a participating pharmacy, click on the Pharmacy Locator link located in the menu bar and enter your criteria. Refer to the Help Desk section for a direct member reimbursement claim form.
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How do I transfer a prescription from a non-participating pharmacy to a participating pharmacy?
There are three ways to transfer your prescription:
- Take your labeled medication container from your previous pharmacy to the participating pharmacy. Your new pharmacy will contact your old pharmacy to transfer your prescription.
- Call the participating pharmacy and ask them to call your old pharmacy for prescription transfer information.
- Ask your doctor to contact the participating pharmacy directly.
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Who should I contact about pharmacy issues?
If you should encounter any issues at a participating pharmacy, please contact the customer contact center toll-free at 888-648-6759 to give a detailed explanation of the issue. A representative will resolve the issue. Refer to the Help Desk section for further contact information.
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Pharmacy Benefit Questions
What is my copayment?
Please refer to your benefit summary provided upon your enrollment, or the Summary Plan Description (SPD) provided by your Plan Sponsor.
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How are copayments determined when a prescription filled by a participating pharmacy is written for less than 30 days or more than 30 days?
Copayments are not prorated based on the number of days prescribed by your physician. If your doctor prescribed a medication for a period of less than 30 days (i.e., a 10-day course of antibiotics), you pay the full applicable copayment amount for 30 days. If the prescription is for more than 30 days, but less than 84 days, your pharmacy benefit may not apply. If your prescription is for 84 to 90 days, you pay the full applicable copayment amount for 90 days.
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Are there any differences in my copayment amounts when using mail order or the 90-day at retail program called Choice90Rx?
If your plan sponsor has allowed for mail order or the 90-day at retail program called Choice90Rx and you take a medication on an ongoing basis, you may be able to save money when you obtain up to a 90-day supply of medication.
Refer to your pharmacy benefit materials as supplied by your plan sponsor to determine if you have a mail order or Choice90Rx option.
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Does my pharmacy benefit cover any medication prescribed by my physician?
Your pharmacy benefit may not cover all medications prescribed by your physician. Some medications may be excluded from coverage. Exclusions may include, but may not be limited to, over the counter (OTC) medications, nicotine smoking cessation products or any drug products used for weight loss or other cosmetic purposes.
To determine if a medication is covered by your pharmacy benefit, please refer to your pharmacy benefit materials as supplied by your plan sponsor.
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Should I provide my physician with a list of medications covered by my pharmacy benefit?
Next time you go to your physician, you should bring your Prescription Drug List or Generic List (whichever list is applicable to your plan – refer to the pharmacy benefit materials supplied by your plan sponsor) to keep with your medical file. By doing so, your physician can help you save money, and reduce the administrative time it takes to change your prescription to a lower cost medication.
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Are all my prescriptions checked for drug interactions?
If you utilize your pharmacy benefit card when you obtain a medication, each drug is sent to the claims system and reviewed for any potential drug interactions based on your personal medication profile before your claim is approved. This evaluation is especially important if you take several different medications or see more than one physician. If the claims system responds with a potential drug interaction, your pharmacist will contact your physician to discuss the potential drug interaction prior to dispensing the medication.
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Can I use my pharmacy benefit card in another state?
If you are in another state on vacation or a business trip, and you need to fill a prescription, you may present your pharmacy benefit card at any participating pharmacy along with your prescription. The pharmacist will process the prescription through the claims system and request the applicable copayment amount. To find a participating pharmacy, click on the Pharmacy Locator link located in the menu bar and enter your criteria.
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Do some drugs have restrictions?
In some cases, your plan sponsor may manage coverage of certain medications regardless of formulary status by requiring certain restrictions. Restrictions may include, but not be limited to quantity limitations, age and gender specifications, prior authorization, or step therapy. Refer to the Glossary of Terms link in the menu bar for term descriptions. For more detailed information, refer to your pharmacy benefit materials as supplied by your plan sponsor.
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What is prior authorization and do I have prior authorization for my medication?
Prior authorization is a process that evaluates a drug's prescribed use against a predetermined set of criteria to determine whether your plan sponsor will cover the medication. Note that if your physician has not submitted a prior authorization request, you will not have a prior authorization in the claims system.
If your physician has submitted a prior authorization and you would like to determine if the prior authorization is in the claims system, please contact the customer contact center toll-free at 888-648-6759.
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What happens if my prior authorization or medical exception request is denied?
In most cases, you will receive a letter from our clinical partner stating a reason for the prior authorization or medical exception request denial. Under certain circumstances, you may have the right to appeal denial decisions. The letter will explain how to file an appeal to your plan sponsor.
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What is a controlled substance?
The federal government has categorized a class of medication as having a higher-than-average potential for abuse or addiction. Such medications, known as controlled substances, are divided into categories based on their potential for abuse or addiction. These medications range from illegal street drugs (C1) to medications with decreasing potential for abuse (C2 through C5). Prescriptions containing narcotics or amphetamines are often classified as C2, since there is a relatively high potential for abuse or addiction.
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How soon can I get a refill?
Your plan sponsor sets the number of days supply you must finish before you are able to get a refill. If your physician allowed for a prescription refill, you can order your next refill after the "order after" date at the bottom of your prescription label.
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What does days supply mean?
Days supply refers to the number of days of medication your physician prescribes. In most cases, your physician will prescribe up to a 30-day supply for short-term (or acute) medications and up to a 90-day supply for ongoing (or maintenance) medications.
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What is a specialty medication?
Your pharmacy benefit may include coverage for certain products that are referred to as specialty medications. These specialty medications are prescribed to treat certain conditions, such as anemia, cancer, cystic fibrosis, growth hormone deficiency, hepatitis C, multiple sclerosis, and respiratory syncytial virus. Most specialty medications are injectables or require special shipping and handling, such as refrigeration. As a result, distribution of specialty medications and additional related services are arranged by a specialty provider.
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Technical Questions
What browser should I use?
The WellPower Member Website will perform best if you use Microsoft Internet Explorer 5.5 or higher or Mozilla FireFox xxx or higher.
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Why do I need to provide my email address when I register and how will it be used by WellPower?
Your email address along with your password is used to help identify you as a registered user each time you sign in. In addition, you may receive email communications about your account or new features that will be implemented on the site. WellPower will not send your personal health information via email.
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If I provide my email address during registration, is it going to be accessed, viewed or 'spammed' by other companies?
WellPower does not share personally identifiable information with third parties, except where specifically stated within our privacy policy, and does not obtain or send advertising from outside vendors.
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The information on this site is not intended to replace the diagnosis and treatment recommendations of your physician or other healthcare professionals. It is a resource to keep you up-to-date about your pharmacy benefit and help you manage your health by providing access to comprehensive health and wellness information.
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