Asking Us to Cover a Medicine - 2010

Ask for a coverage determination

If your doctor or pharmacist tells you that a certain prescription drug is not covered, you should contact us and ask us for a coverage determination. You, your prescribing physician, or someone you name can ask us for a coverage determination by:

• Faxing a completed form to PerformRx at 866-369-6038 for a standard request or 866-533-5491 for an urgent request.
• Calling our Member Services.
• Mailing a completed form to the PerformRx Prior Authorization Department, 200 Stevens Drive, Philadelphia, PA 19113.
• Download the Coverage Determination Form 

Submit an appeal or grievance

If you are not satisfied with our coverage determination decision, you can ask for an appeal called a "redetermination." To learn more about how you can ask us to review our decision, read our Appeals and Grievances Policy.

For More Information

You can learn more about coverage determinations, appeals and grievances by reading Section 9 in our Evidence of Coverage.