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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:

Submit online or fill out the paper form (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

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