Need some help?

Every SCAN employee is trained to understand the needs of people with Medicare, to help you make an informed decision about your Medicare needs.
No, Thank You

Part D Coverage Determination Process

Category: Part D Coverage Determinations & Appeals

Coverage Determination

A coverage determination is an initial coverage decision made by SCAN regarding your Medicare Part D prescription drug. Coverage determinations you can request about your Part D drugs include:


Important Information to Know About Asking for Exceptions

When you ask for an exception, your doctor or other prescriber will need to explain the medical reasons why you need the exception approved. Your doctor or other prescriber must give us a written statement that explains the medical reasons for requesting an exception. For a faster decision, include this medical information from your doctor or other prescriber when you ask for the exception.


What to Do 

You (or your representative or your doctor or other prescriber) may use the form below to submit your request for a Part D Coverage Determination: 

Medicare Prescription Drug Determination Request Form

Please note: If you do not use this form, you will need to provide us the same information indicated in the form so we can process your request in a timely manner.

To start your Part D Coverage Determination request you (or your representative or your doctor or other prescriber) should contact Express Scripts, Inc (ESI):

For additional assistance in making your Part D Coverage Determination request you may call our Member Services Department at:

1-800-559-3500 (TTY User: 711) 8:00 a.m. – 8:00 p.m. PST – Monday – Friday, 9:00 a.m. – 4:00 p.m. – Saturday. Messages received on holidays and outside of our business hours will be returned within 1 business day.

To find out more about the Part D Coverage Redetermination Process, please refer to your Evidence of Coverage (EOC) -- see chapter 9, Section 6: "How to ask for a coverage decision or make an appeal." Or call Member Services at the number(s) listed above.

view all