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Why WellCare…?�2025 WellCare �Texas�

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Agenda:

  • Texas Team
  • Texas Review
  • Service Area
  • Strategic Alliances
  • Prescription Drug Plans
  • Top Plans in Texas
  • Supplemental Benefits
  • Diabetic Testing Supplies
  • Network- Provider Partners

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Texas Team: �Regional Sales Manager-Carlos Candelario Team

Name

Title

State

Sub-Region

Phone Number

Email

Lucero Estorga

Regional Agency Manager

Texas

El Paso/Ector/Lubbock

915-238-6610

Crystal Cariello

Regional Agency Manager

Texas

Houston

346-242-6629

Santiago Medrano

Regional Agency Manager

Texas

Rio Grande Valley/Corpus Christi

956-249-0777

Carmen Pena

Regional Agency Manager

Texas

San Antonio

210-612-4546

Amanda Hernandez

Regional Agency Manager

Texas

San Antonio

210-868-1863

Laura Palacios

Regional Agency Manager

Texas

Rio Grande Valley/Corpus Christi

956-340-2368

Guadalupe Yanez

Regional Agency Manager

Texas

Austin

512-925-8229

Rick Luna

Regional Agency Manager

Texas

Dallas/ Fort Worth

982-380-9653

Karen Gil

Regional Agency Manager

Texas

Dallas/ Fort Worth

817-586-9804

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Texas | Service Area

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Wellcare Continued Coverage Counties:

  • Aransas, Armstrong, Atascosa, Austin, Bailey, Bandera, Bastrop, Bee, Brazoria, Bell, Bexar, Blanco, Borden, Bosque, Brooks, Burleson, Burnet, Caldwell, Calhoun, Cameron, Castro, Chambers, Cochran, Coke, Collin, Colorado, Comal, Cooke, Coryell, Crosby, Dallas, Denton, DeWitt, Dickens, Dimmit, Donley, Duval, Ector, El Paso, Ellis, Fort Bend, Galveston, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grayson, Grimes, Guadalupe, Hardin, Hale, Harris, Hays, Hamilton, Hidalgo, Hill, Hockley, Hood, Hunt, Irion, Jefferson, Jack, Jim Hogg, Jim Wells, Johnson, Karnes, Kendall, Kenedy, Kent, Kimble, Kleberg, La Salle, Lamb, Lampasas, Leon, Lee, Liberty, Limestone, Llano, Lubbock, Lynn, Martin, Mason, Matagorda, Maverick, McCulloch, McLennan, McMullen, Medina, Milam, Mills, Mitchell, Montgomery, Navarro, Nolan, Nueces, Newton, Orange, Palo Pinto, Parker, Polk, Potter, Randall, Rockwall, Real, Refugio, San Jacinto, Starr, San Patricio, San Saba, Shackelford, Smith, Somervell, Starr, Sterling, Swisher, Tarrant, Terry, Throckmorton, Travis, Trinity, Uvalde, Van Zandt, Victoria, Walker, Waller, Webb, Wharton, Williamson, Willacy, Wilson, Wise, Zapata, Zavala

2025 Expansion Counties:

  • Archer, Baylor, Brown, Callahan, Carson, Clay, Coleman, Comanche, Concho, Cottle, Culberson, Dallam, Dawson, Deaf Smith, Eastland, Edwards, Falls, Freestone, Hall, Hansford, Hartley, Haskell, Hutchinson, Jackson, Jones, Kerr, King, Kinney, Knox, Lavaca, Live Oak, Madison, Menard, Moore, Motley, Oldham, Reagan, Roberts, Robertson, Runnels, Schleicher, Sherman, Stephens, Stonewall, Sutton, Taylor, Tom Green, Upton, Washington, Yoakum

Wellcare

2025 Expansion

All information on this slide is subject to change until bids are submitted and approved by CMS.

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Part D Redesign

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2025 Part D Product Design for MAPD

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All information on this slide is subject to change until bids are submitted and approved by CMS.

PART D PROGRAM REDESIGN

CONTINUING IMPROVEMENTS

  • Members will not pay more than $2,000 out of pocket (OOP) for prescription drugs. The three drug phases now include Deductible, Initial Coverage, and Catastrophic phase. The coverage gap has been eliminated for 2025.
  • Medicare Prescription Payment Plan (M3P) or “copay smoothing” gives beneficiaries the option to spread Part D OOP costs monthly over the course of the plan year instead of making upfront payments at the pharmacy. Wellcare’s M3P program will be implemented by Jan. 1, 2025, and will be delegated to Express Scripts.
  • All plans will offer $0 copay for most Part D preventive vaccines regardless of network pharmacy used by members. Plans offer $0 COVID vaccines under Part B.
  • All plans will have a $35 cap on cost-sharing for a one-month supply for covered insulin medications for all coverage phases.
  • MAPD plans will continue to offer Tier 1 excluded drug coverage of generic Viagra, generic Levitra, and select vitamins including Vitamin D, injectable Vitamin B12, and Folic Acid. Not offered on D-SNP and Low-Income Subsidy (LIS) plans.

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2025 PBM Network Updates

  • Pharmacy Benefit Manager
  • Express Scripts will continue to manage pharmacy benefits administration. This will impact all
  • Part D plans, including MAPD and PDP.
  • Medication Home Delivery
  • Express Scripts is the preferred mail order benefit provider; 100-day extended supply available.
  • Preferred mail order discounts are available:
    • Tiers 1, 2, and 6 = $0 copay for 100-day supply
    • Tiers 3 and 4 = Coinsurance applies
    • Tier 5 = Coinsurance applies, limited to 30-day supplies

Confidential and Proprietary Information

All information on this slide is subject to change until bids are submitted and approved by CMS.

Preferred Pharmacy Network

  • Walgreens and CVS plus grocers remain within the preferred pharmacy network for 2025.

Manufacturer Discount Program

  • The Manufacturer Discount Program will require manufacturer discounts for applicable drugs; replaces the Medicare coverage gap discount program.

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Supplemental Benefits

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Vendors

Transportation: Modivcare- wellcare 866-393-2166 wellcare by Allwell 877-718-2401

PERS (Personal Emergency Response System): VRI 800-750-8694 Option 2

Routine Hearing: Hearing Care Solutions-877-374-4056

Fitness Benefits: Silver & Fit- 877-427-4788

Dental: - Liberty Dental 866-544-4669

Vision: Premier Vision 855-879-1456

Spendables card : Solutran 855-744-8550

​

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2025 Products

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Top Plans in TEXAS by Region

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Wellcare Simple (HMO) El Paso

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Wellcare Simple (HMO) Houston

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Wellcare TexanPlus Classic Simple (HMO-POS) Houston

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Wellcare Simple (HMO) RG Valley/Corpus Christi

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Wellcare Mutual of Omaha Simple Secure Open (PPO) Houston

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Wellcare Mutual of Omaha Simple Secure Open (PPO) Dallas

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Wellcare Dual Reserve (HMO D-SNP)

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Wellcare Assist (HMO)

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Wellcare Dual Access (HMO D-SNP)

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Wellcare Dual Liberty (HMO D-SNP)

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Wellcare Dual Reserve (HMO D-SNP)

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Wellcare Dual Access (HMO D-SNP)

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Wellcare Dual Liberty (HMO D-SNP)

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Provider Partners in Texas

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Thank you!

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