Request for Medicare Prescription Drug Coverage Determination
This form may be sent to us by mail or fax:
ATTN: Benefit Coverage Review Department
PO Box 66587
St. Louis, MO 63166-6587
You may also ask us for a coverage determination by phone at 1-855-475-3163 (TTY 1-800-750-0750 or 711).
or through our website at: https://www.caresource.com/oh/members/tools-resources/grievance-appeal/mycare/ We are open 8 a.m. - 8 p.m. Monday through Friday.
Who May Make a Request: Your prescriber may ask us for a coverage determination on your behalf. If you want another individual (such as a family member or friend) to make a request for you, that individual must be your representative. Contact us to learn how to name a representative.