Coverage Review Instructions
If one of your patients or a pharmacist requests your help in completing a coverage review, you can start the process by fax or telephone. By fax
- Download our online fax form here.
- ill in the patient, prescription, and prescriber sections. (Clearly printed writing will help to expedite the processing of this form.)
- Fax the form without a cover sheet to 1 800 711-5673.
- Upon receipt of the completed form, we will fax you the appropriate questionnaire. If your request is faxed during the hours of 8:00 a.m. to 9:00 p.m., eastern time, Monday through Friday, you can expect the questionnaire faxed to you within 24 hours of your request. If the request is received outside of these time frames, the questionnaire will be faxed to you the next business day.
- Complete the questionnaire, and return it to UA Medicare Part D for final processing.
- Once the completed questionnaire is returned to Medco, a coverage decision will be faxed to you, usually within 1 business day. In addition, a letter that confirms or denies coverage approval will be sent to both you and the patient.
By telephone
- Call toll-free 1 800 753-2851 to initiate the review.
- Medco will fax a form for you to fill out and return (the fax number is indicated on the form). Please note that a timely response is important.
- Medco will send you and your patient a letter that confirms or denies coverage approval (usually within 2 business days of receiving the necessary information).
- If coverage is approved, your patient will pay the applicable co-payment. If coverage is not approved, the letter will provide the denial reason, and your patient will be responsible for the entire cost of the medication. Your patient has the right to appeal the decision.
