A coverage decision is a decision we make about your benefits and coverage or about the amount we will pay for your prescription drugs.
We are making a coverage decision for you whenever we decide what is covered for you and how much we pay. In some cases, we might decide a drug is not covered or is no longer covered by Medicare for you.
Here are examples of coverage decisions you ask us to make about your Part D drugs:
If you disagree with this coverage decision, please visit our Grievances & Appeals page for more information on the appeal process.
Request the type of coverage decision you want. Start by calling, writing, or faxing us to make your request. You, your representative, or your doctor (or other prescriber) can do this. You may call our Customer Care Center if you have questions about our coverage decision process.
Banner Medicare Rx
Attn: Customer Care Center
2701 E. Elvira Road
Tucson, AZ 85756
Customer Care Center: (844) 549-1859, TTY 711
If we deny your coverage request, you have the right to request an appeal. Requesting an appeal means asking us to reconsider – and possibly change – the decision we made.
Visit our Grievances & Appeals page for more information on the appeal process.
Visit our Appointment of Representative page for more information on appointing an individual to act as your representative.