Part D Coverage and Determination Appeals

You can get the request form to begin the process for a prescription drug to be covered, that is not already covered. Your physician will need to fill out the Part D Coverage Determination form.

You can find the form here: Request for Prescription Drug Coverage Determination

Standard requests have a 72-hour timeframe to be resolved. This begins once the prescribing physician or prescriber provides supporting documentation.

Expedited requests have a 24-hour timeframe to be resolved. This begins once the prescribing physician or prescriber provides supporting documentation.

Because we denied your request for coverage of (or payment for) a prescription drug, you have the right to ask us for a redetermination (appeal) of our decision. You have 60 days from the date of our Notice of Denial of Medicare Prescription Drug Coverage to ask us for are determination. This form may be sent to us by mail or fax.

You can ask us to “expedite” or give you a quick decision if we have denied coverage and you believe using the standard deadlines could cause serious harm to your health or hurt your ability to function.
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See the Request for Redetermination of Medicare Prescription Drug Denial form here.

If you need assistance, call Member Services.