Appeals for Part D (Pharmacy) Benefits
You can generally "appeal" our decision not to cover a drug, vaccine, or other Part D benefit. You may also appeal our decision not to reimburse you for a Part D drug that you paid for or if you think, we should have reimbursed you more than you received or if you are asked to pay a different cost-sharing amount than you think you are required to pay for a prescription.
If we deny an exception request or you received an adverse coverage determination, you can appeal. You need to file your standard appeal within 60 calendar days from the date included on the specific notification such as the notice of coverage determination. We can give you more time if you have a good reason for missing the deadline.
To file a standard appeal, you, your designated representative, or your prescribing physician can complete the Request for Redetermination Form and submit by fax, mail, or in person. You may also call Clarion Health Member Services toll-free at 1-844-824-8771, available from April 1 to September 30, Monday – Friday, 8 a.m. to 8 p.m. EST and from October 1 to March 31, 7 days a week, 8 a.m. to 8 p.m. EST (TTY users call 711).
You can send the form or another signed request to:
- Clarion Health
- P.O. Box 21363
- Attn: Pharmacy Services
- Eagan, MN 55121
- Or via Fax: 866-427-7676