Request for Medicare Prescription Drug Coverage Determination
This form may be sent to us by mail or fax:
ATTN: Medicare Review
PO Box 66571
St. Louis, MO 63166-6571
You may also ask us for a coverage determination by phone at:
- 1-844-607-2827 (TTY: 711) for CareSource Advantage® Zero Premium and CareSource Advantage® members, or
- 1-833-230-2020 (TTY: 711) for CareSource Dual Advantage™ (HMO D-SNP) members
or through our website at: https://www.caresource.com/members/tools-resources/grievance-appeal/part-d-prescription-plan-rights/ We are open 8 a.m. to 8 p.m. Monday through Friday, and from October 1 through March 31, we are open the same hours, seven 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.