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CVS Caremark January 1, 2018 Formulary Update
Delaware County Intermediate Unit: Prescription Drug Appeal Process
The Delaware County Intermediate Unit (DCIU) offers prescription drug coverage to full time employees through CVS/Caremark. Similar to other medical plans, the prescription drug benefit plan has requirements, restrictions, limitations and exclusions. As a result, the DCIU has a formal appeal process that allows members to contact an independent party for appeal submission, review and determination. The independent party will ensure that the appeal determination is unbiased and based on clinical documentation. Please be advised that the Benefits Office cannot provide prescription overrides.
You or your authorized representative (who may be your doctor) may submit an appeal of a denial in writing along with any documentation that will support your appeal. That documentation should include any information that you or your doctor believe supports your claim. This information could include a letter from your doctor describing why the requested medication is necessary, clinical notes, test results or any other supporting documentation.
Appeal Process:The request for review must be submitted in writing and include supporting clinical document. The request may be faxed or mailed via the following:Standard Appeals:
Fax: 1-866-443-1172; Attention: Appeals DepartmentMail: CVS/Caremark, Inc.Appeals Department MC 109P.O. Box 52084Phoenix, AZ 85072-2084Specialty Appeals:
Fax: 1-855-230-5548; Attention: Appeals DepartmentMail: CVS/Caremark Inc.Specialty Guideline Management Appeals Department800 Biermann Court Suite BMt. Prospect, IL 60056