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TRICARE Transition Challenges in the West Region
We are aware of the customer service issues our patients are experiencing in the West Region. Learn more about how we are fixing these issues, including waiving our usual authorization process through March 18.

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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
Express Scripts, Inc.

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

Express Scripts Website

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