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Coverage & Appeals

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:


  1. Online: Complete our online Request for Redetermination of Medicare Drug Denial (Part D appeal) form.
  2. 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.
  3. Mail: Wellcare
              Medicare Pharmacy Appeals
              P.O. Box 31383
              Tampa, FL 33631-3383
  4. Fax: 1-866-388-1766
  5. 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).

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Y0020_WCM_134133E_M Last Updated On: 10/1/2023
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