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Request for Medicare Prescription Drug Coverage Determination

I I I I REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent

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NAME (NOMBRE) ______________________________________________________________________ ADDRESS (DIRECCIÓN) ________________________________________________________________ ___________________________________________________________________________________ MEMBER ID ( NÚMERO DE MEMBRESÍA) ____________

Behavioral Health Redesign

Behavioral Health Redesign

Ohio Rise |

A page for potential members to learn more information about Ohio Rise

Find a provider |

A page for members to learn more information on how to find a provider.

Search

Search results page for Aetna Better Health of Ohio

Search

Search results page for Aetna Better Health of Ohio

Find a provider

Use this feature to find an Aetna Better Health of Ohio provider.

Coverage Determination

Form to request a drug be covered for you

Log in

Here you can log into the Aetna Better Health of Ohio website.

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