Why is it critical for Wellcare employees to understand drug formularies?

Understanding drug formularies is essential for Wellcare employees primarily because it allows them to assist members with medication coverage and help navigate potential costs. Drug formularies are lists of medications that are covered by a health insurance plan, and they often categorize drugs into different tiers based on factors like cost, effectiveness, and necessity.

When employees are knowledgeable about which medications are included in the formulary and how different tiers affect out-of-pocket costs for members, they can provide valuable guidance. This includes helping members understand what medications they may need to switch to for better coverage or explaining the financial implications of prescribed medications. This knowledge significantly contributes to improved member satisfaction, adherence to treatment plans, and overall health outcomes.

Additionally, employee awareness of the formulary can empower them to proactively address member questions and concerns regarding medication options, leading to more informed decisions by the members regarding their healthcare.