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 or download the form here.

Aetna Better Health Premier Plan
Part D Appeals, Pharmacy Department
4750 S. 44th Place Suite 150
Phoenix, AZ 85040-4015

Attn: Redeterminations

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.