Request for Medicare Prescription Drug Coverage Determination
This form may be sent to us by mail or fax:
CareSource
c/o CVS Caremark
MC109
P.O. Box 52000 Phoenix, AZ, 85072-2000
c/o CVS Caremark
MC109
P.O. Box 52000 Phoenix, AZ, 85072-2000
Fax Number
1-855-633-7673
1-855-633-7673
InformationYou 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/mycare/ We are open 8 a.m. - 8 p.m. Monday through Friday and from Oct. 1 - Feb. 14 we are open the same hours 7 days a week.
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.