Coverage Determination Requests

Request a coverage decision and/or exception or file an appeal of a drug coverage decision.

• Online: Request Prescription Drug Coverage
• Fax or Mail: Complete a request for prescription drug coverage.

Medication Appeals

You may appeal a coverage determination decision by contacting our Pharmacy Appeals Department. Please complete a medication appeal request.

• Online: Request Appeal for Drug Coverage using our online form
• Fax or Mail: Complete an appeal of coverage determination request.