Pharmacy Initial Coverage Determination or Exception Requests
A coverage determination is a decision made by our plan (not the pharmacy) about your Part D prescription drug benefits. To ask for a coverage determination, fill out the Coverage Determination Form.
Forms can be submitted to:
Express Scripts
Attn: Medicare Reviews
PO Box 66571
St. Louis, MO 63166-6571
Fax: 877-251-5896
You can also request a coverage determination through electronic PA. Click here for more information on how to submit a Medicare Coverage Determination through electronic method.
Pharmacy Redetermination or Part D drug Appeal
If Sentara Health Plans denies a request for Medicare prescription drug coverage, you may request a redetermination or appeal. To initiate a redetermination, download and fax in the Redetermination Form to:
Express Scripts, Inc.
Attn: Medicare Clinical Appeals
P.O. Box 66588
St. Louis, MO 63166-6588
Fax: 877-852-4070
You can also request electronically. Click here for more information on how to submit a Medicare Coverage Determination through electronic method.