Coverage Redetermination Form

Coverage Redetermination Form

Because we, Aetna Better Health℠ Premier Plan, denied your request for coverage of (or payment for) a prescription drug, you have the right to ask us for a redetermination (appeal) of our decision. You have 60 days from the date of our Notice of Denial of Medicare Prescription Drug Coverage to ask us for a redetermination.

Fill out the Coverage Re Determination Form online

Mail
Aetna Better Health℠ Premier Plan
Part D Appeals, Pharmacy Department
4500 E. Cotton Center Blvd.
Phoenix, AZ 85040

Fax
Attn: Redeterminations
1-844-242-0914   

Expedited appeal requests can be made by phone at 1-855-676-5772 (TTY: 711). We are available 24 hours a day, 7 days a week.

Who may make a request: Your prescriber may ask us for an appeal on your behalf. If you want another individual (such as a family member or friend) to request an appeal for you, that individual must be your representative. Contact us to learn how to name a representative.