Prescription Drug Documents
To ask for a Coverage Determination or Exception about Medicare Part D prescription drugs, you may need to complete the Medicare Prescription Drug Coverage Determination Form (106 MB). You may also ask us for a coverage determination by phone at 1-800-963-0035 or at this web link.
Online Coverage Determination Requests With PromptPA
The PromptPA website lets you and your health care providers submit Coverage Determination/ Prior Authorization requests online for your prescription drugs. You can also see the status and outcome of these requests on the site.
- To get started, visit PromptPA and click on the "Members" link. You do not need to register.
To ask for a redetermination (appeal) of our decision when we deny your request for coverage of (or payment for) a prescription drug, you may complete the Request for Redetermination of Medicare Prescription Drug Denial (45 KB)
More information about Grievance and Appeals and asking for a Coverage Determination or Exception about your medical care, and Medicare Part D prescription drugs is available on the Grievance and Appeal Process page.
Multi-language Interpreter Services (163 KB)
You will need Adobe Acrobat Reader to view and print PDF files of program materials, which provide details about Partnership benefits and other important member information (Download a free copy of Adobe Acrobat Reader).