To request a coverage decision, your doctor or prescriber can fill out our Request for Medicare Prescription Drug Coverage Determination form (PDF), or you can call us at 855.393.3154 (TTY:711), seven days a week, from 8 a.m. to 8 p.m.
If you prefer to mail your form, print, complete and mail your Request for Medicare Prescription Drug Coverage Determination form to:
Tufts Health Plan
Attn: Pharmacy Utilization Management Department
P.O. Box 9194
Watertown, MA 02471-9194
You will need the following information in order to complete the form or make your request over the phone:
- The name of the prescription drug you believe you need, including the dose and/or strength, if known
- The date the pharmacy rejected your prescription
- If you're asking for an exception, your doctor or prescriber will need to provide us with a statement explaining:
- Why you need the nonformulary drug
- Why the coverage rules should not apply to you
- Why an exception should be made
Once we receive and process your request, we will send you a written decision. If we do not approve your requested coverage, we will explain why this coverage was denied.