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Request for Medicare prescription drug coverage determination

How to contact us when you are asking for a coverage decision about your Part D prescription drugs:

Submit online or fill out the paper form (PDF).

Fax, expedited: 1-855-825-2712
Fax, standard: 1-855-825-2711
Call us: 1-888-978-0862 (TTY/TDD 711), 24 hours a day, 7 days a week
Write us:
First Choice VIP Care Plus
Attn: Pharmacy Prior Authorization/Member Prescription Coverage Determination
PerformRx
200 Stevens Drive
Philadelphia, PA 19113

H8213_001_WEB_318369 _Approved_11132018