Request for Medicare prescription drug coverage determination
How to contact us when you are asking for a coverage decision about your Part D prescription drugs:
- To submit electronically, please submit an Electronic Prior Authorization (ePA) through your Electronic Health Record (EHR) tool software, or you can submit through any of the following online portals:
- Or fill out the paper form (PDF) PDF.
Fax urgent: 1-855-516-6381
Fax standard: 1-855-516-6380
Call: 1-800-450-1166 (TTY/TDD 711), 8 a.m. to 8 p.m., Monday — Friday
Write:
Attn: Pharmacy Prior Authorization/Member Prescription Coverage Determination
PerformRx
200 Stevens Drive
Philadelphia, PA 19113
Y0093_WEB_318377