Request for Medicare Prescription Drug Coverage Determination
This form may be sent to us by mail or fax:
c/o Medicare Clinical Appeals
PO Box 66588
St. Louis, MO 63166-6588
You may also ask us for a coverage determination by phone at 1-844-607-2827 (TTY 1-800-750-0750 or 711).
or through our website at: https://www.caresource.com/members/ohio/medicare/my-right-to-file-a-grievance-or-appeal/part-d-prescription-drug-plan-rights/ 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.