What Are Medically Necessary Drugs?
Medically necessary drugs are drugs you need to get and stay well. As required by NJ FamilyCare, WellCare covers such drugs. We also use a Preferred Drug List (PDL). These are the drugs that we want your doctor use. The drugs on the PDL are sorted by brand and generic name. They are also sorted by quantity, gender and age limits.
Printed Preferred Drug Lists
- WellCare of New Jersey Medicaid Preferred Drug List (PDF)
- New Jersey Medicaid Machine Readable File
- WellCare of New Jersey Supplemental Preferred Drug List (PDF)
- WellCare of New Jersey Notice of Change (PDF)
Drugs that Require Prior Approval (and are not on our PDL)
Your provider must send us a Coverage Determination Request (CDR). We also allow a drug store to give you a 72-hour supply of a drug (on or not on our PDL) that needs a prior approval.
There are some medicines we will not cover. They include:
- Those used for eating problems or weight gain
- Those used to help you get pregnant
- Those used for erectile dysfunction
- Those that are for cosmetic purposes or to help you grow hair
- DESI (Drug Efficacy Study Implementation) drugs and drugs that are identical, related or similar to such drugs
- Investigational or experimental drugs
- Those used for any purpose that is not medically accepted
Drug Evaluation Request Forms
- Drug Recall 1 (PDF)
- Drug Recall 2 (PDF)
- Drug Recall 3 (PDF)