A Coverage Determination Request is a Prescription Part D Drug Coverage decision made by Verda Health Plan of Texas. Different Part D Coverage determinations you can request include:
- Whether a drug is covered for you and whether you satisfy any coverage rules. (Typically, when your drug requires our approval before it is covered despite being on the Plan’s List of Covered Drugs.)
- Reimbursement for a prescription drug you already bought.
- A Formulary exception. (If a drug is not covered in the way you would like it to be covered, you can ask the Plan to make an “exception.”) Examples include:
- Asking for coverage of a drug that is not on the drug list
- Asking to pay a lower cost-sharing amount for a covered non-preferred drug
- Asking us to remove the extra rules and restrictions on the Plan’s coverage for a drug such as:
- Being required to use the generic version of a drug instead of the brand name drug
- Getting plan approval in advance before we will agree to cover a drug for you
- Quantity Limits
Important Information to Know About Asking for Exceptions
When you ask for an exception, your doctor or other prescriber will need to provide us with a written statement explaining the medical reasons for requesting an exception. For an expedited decision, include this medical information from your doctor or other prescriber when you ask for the exception.
What to Do
You (or your representative or your doctor or other prescriber) may use the form below to submit your request for a Part D Coverage Determination:
Medicare Prescription Drug Determination Request Form
To start your Part D Coverage Determination request you (or your representative or your doctor or other prescriber) should fill out the Online Coverage Determination Request Form below, or contact MedImpact:
mp.medimpact.com/partdcoveragedetermination
Phone number: 866-705-4182
Fax: 858-790-7100
www.medimpact.com
10181 Scripps Gateway Court
San Diego, CA 92131
To find out more about the Part D Coverage Redetermination Process, please refer to your Evidence of Coverage (EOC) or call Member Experience.