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 pre-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.