Request Appeal for Medicaid Drug Coverage
Who May Make a Request
Your prescriber may ask us for an appeal on your behalf. If you want another individual (such as a family member or friend) to request an appeal for you, that individual must be your representative. Contact Us to learn how to name a representative.
Because we, Fidelis Care, denied your request for coverage of (or payment for) a prescription drug, you have the right to ask us for redetermination (appeal) of our decision. You may ask for a redetermination after the date of our Notice of Action.
- A Medicaid Medication Appeal Request (PDF) may be faxed to us at to 1-888-865-6531.
Expedited appeal requests can be made by phone at 1-866-800-6111.