Request a Coverage Determination including Formulary Exception

Before you request a drug determination, please call Participant Services at 1-855-675-7630 (TTY 711), 24 hours a day, 7 days a week, and ask if your drug is covered. If you request an exception, your doctor must provide a statement to support your request. Once we receive a statement from your doctor, we must make a coverage determination and notify the affected member within 72 hours of receiving the request, or sooner if their health condition requires more immediate action. If immediate action is necessary, you or your physician can request that we review your situation in 24 hours.

We accept request for a coverage determination by mail, email, phone, or fax.

CVS Caremark Part D Services
MC109
P.O. Box 52000
Phoenix, AZ 85072-2000
1-855-675-7630
(TTY 711)
24 hours a day, 7 days a week
Fax: 1-855-633-7673
MedicareCoverageDeterminations@caremark.com

Please note: Often CVS Caremark will not have all of the information it needs to make a coverage determination. In those cases, an extra 2 weeks is allowed to gather all necessary supporting documentation. In addition, if we approve your exception request for a non-formulary drug, you cannot request an exception to the copay you must pay for the drug.

H5441_GEN15_38 RA 06/2015