Because we, CVS Caremark, 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 65 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:
Address:
CVS Caremark
Appeals Dept.
MC109
PO Box 52000
Phoenix AZ 85072-2000
Fax Number:
1-855-633-7673
Expedited appeal requests can be made by phone 24 hours a day, 7 days a week.
Oklahoma Members Call: (1-866-494-3927)
Arizona Members Call: (1-844-449-0358)
Texas Members Call: (1-844-449-0360)
Who May Make a Request:
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.