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Medicare Drug Appeal

If you are requesting an initial coverage determination or exception for your drug coverage, please call 1-855-479-3659 or submit by following the instructions at: https://hmsa.com/help-center/forms/medicare-drug-review/.

If we deny coverage or payment for a prescription drug, you have the right to appeal our decision. You have 60 days from the date of the denial notice to submit your appeal.

Your physician or provider prescribing the medication can submit an appeal for you. Anyone other than the prescriber, like a family or friend, must be your representative. Learn how to name a representative.

If you need help completing this form or if you have questions about the appeal process, call HMSA's Member Advocacy and Appeals staff at 808-948-5090 on Oahu or 1-800-462-2085 toll-free.

Do you need an expedited decision?

A standard appeal takes seven days. If your prescriber indicates that waiting could seriously harm your health, we will automatically give you a decision within 72 hours.

If you don't obtain your prescriber's support for an expedited appeal, we will decide if your case requires a fast decision.

Expedited appeal requests may also be made by phone at 1-800-462-2085 or 948-5090.

What prescription drug are you requesting?

Who is the prescription drug for?

Include any information you believe may help your case, such as

  • Relevant medical information
  • Reason why you need an expedited appeal

You may want to refer to the explanation we provided in the Notice of Medicare Prescription Drug Coverage.

CURRENT AS OF 10/1/2022