21-847m 2022 Individual Wellcare By Health Net Plan Codes, Service Area Changes and Medicare Part D Formulary
Date: 11/30/21
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.
Review service area plan codes and see what’s changing in the Medicare formulary
Individual Wellcare By Health Net plan codes, county availability and Centers for Medicare & Medicaid Services contract identification numbers are provided on the 2022 Wellcare By Health Net Plan Codes by County flyer (PDF).
Use the new information in the flyer to submit your monthly reporting.
2022 available optional supplemental packages
The three optional supplemental packages are provided below. County availability is shown below.
Package # | Package name | Benefit highlights |
|---|---|---|
1 | Enhanced dental | Preventive and comprehensive dental |
2 | Enhanced dental and fit plus | Chiropractic services, acupuncture, preventive and comprehensive dental, eye exams, and eyewear |
3 | Vision 300, 36 CAM1 visits | Chiropractic services, acupuncture, other defined supplemental benefits, eye exams, and eyewear |
1 CAM = Complementary and alternative medicine
Northern California
Package # | Alameda | Amador | Contra Costa | Fresno | Placer | Sacramento | San Francisco | Santa Clara | Stanislaus | Yolo |
1 | X | X | X | X | X | X |
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| X | X |
2 | X | X | X |
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| X | X |
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3 |
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| X | X |
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| X |
Southern California
Package # | Imperial | Los Angeles | Orange | Riverside | San Bernardino | San Diego |
1 | X | X | X | X | X | X |
2 |
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3 |
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Medicare Part D
On January 1, 2022, some drugs will no longer be covered on our Medicare Part D formulary. To assist our providers, we have included a list of the most commonly prescribed drugs being removed along with the drugs’ 2022 formulary alternative(s) below. Please refer to the list to identify the appropriate options for your patients.
If you determine that it is necessary for your patient to continue to receive the non-formulary drug in 2022, you will need to submit a Coverage Determination request no sooner than November 1, 2021.
Download the Medicare Part D Coverage Determination Request form or you can call to request authorization.
If you have any questions, please contact Medicare Pharmacy Services at 800-867-6564.
Product name | Formulary alternative |
|---|---|
BYDUREON® Pen (product discontinued) | BYDUREON BCise® auto injection |
Auryxia® | Calcium acetate (phosphate binder) capsule/tablet, sevelamer carbonate |
Trulance® | Linzess® capsule, lubiprostone capsule |
Brinzolamine ophthalmic suspension 1% | Azopt, dorzolamide |
Additional information
If you have questions regarding the information contained in this update, contact the Provider Services Center within 60 days, by phone or through the provider website as listed below.
800-929-9224