Request for Redetermination of Medicare Prescription Drug Denial
Because we CareSource® MyCare Ohio (Medicare-Medicaid Plan) 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 a redetermination. This form may be sent to us by mail or fax:
c/o CVS Caremark
P.O. Box 52000 Phoenix, AZ, 85072-2000
You may also ask us for an appeal through our website at: https://www.caresource.com/mycare/
Expedited appeal requests can be made by phone at: 1-855-475-3163. If you have a hearing or speech impairment, please call us TTY 1-800-750-0750 or 711. 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 an appeal on your behalf. If you want another individual (such as a family member or friend) to request an appeal for you, that individual must be your representative. Contact us to learn how to name a representative.