A coverage determination is an initial coverage decision made by Clever Care 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 Medimpact at (800) 926-3004 (TTY: 711).
MedImpact Healthcare Systems, Inc.
PO Box 509108
San Diego, CA 92150-9108
For additional assistance with making your Part D Coverage Determination request you may call our Customer Service Department.
Refer to your Evidence of Coverage, Chapter 9, Section 6 to find out more about the Part D Coverage Redetermination Process.