Request Drug Coverage

Request That a Drug is Covered

It is your right to request that we cover a drug that we do not typically cover or cover a drug that has restrictions. Your provider can help you request a coverage decision, also called a coverage determination, and provide reasons why he/she thinks you need the drug.

How do I request a coverage decision?

You, your doctor, or an appointed representative can request a coverage decision on your behalf. Please complete the Model Drug Coverage Determination Form and submit it to us one of the following ways:

  • Online: Complete the online form* and submit it right away 
  • Mail to: 2181 E. Aurora Road, Suite 201, Twinsburg, OH 44087 
  • Fax to: 1-877-503-7231 
  • Call: Member Services 1-855-833-8125, TTY: 1-866-765-0055 

What happens next?

We will review your request and then make a coverage determination, which is a decision about whether we will cover the drug you requested and the amount, if any, that you are required to pay for the drug. We will notify you of our decision within 72 hours from when we received your request. If your doctor agrees that waiting 72 hours will harm your health, you or your doctor can ask us for a faster decision. If you submit the request, your doctor must also call or write us to confirm the need. We will then give a decision within 24 hours. 

If your request is not approved, you have the right to appeal our decision.

Related Forms and Policies


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H9585_117_092015_Approved
Last Updated 02/09/16