Please provide as much information as possible to submit your determination request online.
If preferred, you may also submit your request by mail or fax:
Address:
CVS Caremark
Part D Exceptions Department
MC109
PO Box 52000
Phoenix AZ 85072-2000
Fax Number:
1-855-633-7673
Who May Make a Request:
Your prescriber may ask us for a coverage determination on your behalf. If you want another individual (such as a family member or friend) to make a request for you, that individual must be your representative. Contact us to learn how to name a representative.
Rationale for Request