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.
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.