Coverage Determination FIDA

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 you within 72 hours of receiving the request, or sooner if the health condition requires more immediate action. If medically necessary, you or your doctor can request that we review your situation within 24 hours.

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

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

Please note: Sometimes CVS Caremark won’t have all of the information it needs to make a coverage determination. In those cases, an extra two weeks is allowed to gather all necessary supporting documentation. Also, 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