Redeterminations (Part D Appeals)
If we deny your request for a coverage determination (exception), or a payment for a drug, you, your doctor, or your representative may ask us for a redetermination. You have 60 days from the date of our coverage denial letter to request a redetermination. You can complete the Redetermination form, but you do not have to use it.
You can ask for a drug coverage redetermination one of the following ways:
- Online: Complete our online Request for Redetermination of Medicare Drug Denial (Part D appeal) form.
- Drug Coverage Redetermination Form (PDF): Request for Redetermination of Prescription Drug Denial (PDF)
- This form can also be found on your plan's Pharmacy page.
- Mail: Wellcare
Medicare Pharmacy Appeals
P.O. Box 31383
Tampa, FL 33631-3383 - Fax: 1-866-388-1766
- Phone: Contact Us.
An expedited redetermination (Part D appeal) request can also be made by phone at Contact Us.
If you or your doctor states that waiting 7 days for a standard decision could seriously harm your health or ability to regain maximum function, you can ask for a fast (expedited) decision. If your doctor states this, we will automatically give you a decision within 72 hours. If we do not receive your doctor’s supporting statement for an expedited appeal, we will decide if your case requires a fast decision. You cannot request an expedited appeal if you are asking us to pay you back for a drug you already received.
For more information about coverage determinations (exceptions) and redeterminations (Part D appeals), please refer to your Evidence of Coverage (EOC).
