Request for Redetermination of Medicare Prescription Drug Denial
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Because we denied your request for coverage of (or payment for) a prescription drug,
you have the right to ask us for a redetermination (appeal) of our decision.
You have 60 days from the date of our Notice of Denial of Medicare Prescription Drug Coverage to ask us
for a redetermination. This form may be sent to us by mail or fax:
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You may also ask us for an appeal through our website at
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Expedited appeal requests can be made by phone at (866)567-7242.
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Your prescriber may ask us for an appeal on your behalf. If you want another
individual (such as a family member or friend)
to request an appeal for you, that individual must be your representative.
Contact us to learn how to name a representative.
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