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Pharmacy Appeals

You can file a pharmacy appealThe action you take if you don’t agree with a decision made about your benefit. if you disagree with a decision about your pharmacy benefit. For example, Express Scripts denies:

  • Your pharmacy claim
  • Your request for medical necessity for a specific drug
  • Your request for prior authorization

To file a pharmacy appeal, you should:

Send letter to Express Scripts. Make sure the postmark is within 90 days of the date of the decision.

  • State specifically why you disagree.
  • Include a copy of the claim decision.
  • Include any supporting documents.
  • If you don’t have all the supporting documents, send the appeal with what you have. Make sure to state that you’ll send more information soon.

You may request a second level appeal if Express Scripts denies your appeal. The appeal decision letter from Express Scripts will give you specific instructions for this.

Last Updated 2/1/2016

contact Your Contacts

Pharmacy Appeals

Stateside: 1-877-363-1303
Overseas: 1-866-275-4732 
(where toll-free service is established)

P.O. Box 60903
Phoenix, AZ 85082-0903

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