If a member is requesting a coverage determination or an exception, please fill out the appropriate form below and fax your request to Express Scripts at 877-837-5922.
A decision about whether VillageHealth will cover a Part D prescription drug can be a “standard” coverage determination (prior authorization) that is made within the standard timeframe typically within 72 hours. Turn around times for non- formulary exceptions and tier exceptions are typically within 72 hours upon receipt of completed information. If incomplete information is given, then the turnaround time will be delayed up to 14 days. Once a decision has been made, Express Scripts will send a letter to the physician's office and the member regarding the decision of the coverage determination.
To check the status of a coverage determination and exception request, please call Express Scripts at
1-800-417-8164. A representative is available 24 hours a day, seven days a week. TTY users should call
1-800-899-2114.
To view all of the Prior Authorization Criteria please
click here
Physician Coverage Determination Link