Services

Resources for Express Scripts Medicare® Prescription Plan Members

Express Scripts Medicare Formulary

The Express Scripts Medicare Part D formularies are reviewed by a Pharmacy & Therapeutics Committee composed of physicians and pharmacists who have been approved by the Centers for Medicare & Medicaid Services (CMS).

The formulary is a list of the prescription drugs that are approved for coverage under the Express Scripts Medicare Plan. Be sure to select the formulary that applies to the member's plan option.

View the Formulary Changes for Express Scripts Medicare Part D Prescription Drug Plans

View the list of drugs that have quantity limits, step therapy, or prior authorization requirements and the rules that apply to each drug.

Coverage Determination and Redetermination

To initiate the coverage review process or to initiate an appeal of a previously declined coverage review request, please use the resources below.

If you would like to request a coverage determination (such as an exception to the rules or restriction on our plan's coverage of a drug) or if you would like to make an appeal for us to reconsider a coverage decision, you may contact us via phone, mail or fax:

Initial Coverage Decision and Appeals
Use this contact information to initiate the coverage review process.
Phone (toll-free): 1.800.935.6103
24 hours a day, 7 days a week.
TTY Users (toll-free): 1.800.716.3231
Fax the appropriate
form to:
1.877.329.3760
Mail the appropriate
form to:
Express Scripts
Attn: Medicare Reviews Department
PO Box 66571
St. Louis, MO 63166-6571

Administrative Coverage Decision and Appeals
Use this contact information if you need a decision about whether a medication is covered.
Phone (toll-free): 1.800.413.1328
9:00 a.m. - 7:00 p.m., Monday through Friday (Eastern Time)
TTY Users (toll-free): 1.800.716.3231
Fax the appropriate
form to:
1.877.328.9660
Mail the appropriate
form to:
Express Scripts
Attn: Medicare Admin Appeals Department
PO Box 66587
St. Louis, MO 63166-6587

Clinical Coverage Decision and Appeals
Use this conatct information if you need a decision about a restricion on a specific medication.
Phone (toll-free): 1.800.935.6103
9:00 a.m. - 7:00 p.m., Monday through Friday (Eastern Time)
TTY Users (toll-free): 1.800.716.3231
Fax the appropriate
form to:
1.877.852.4070
Mail the appropriate
form to:
Express Scripts
Attn: Medicare Clinical Appeals Department
PO Box 66588
St. Louis, MO 63166-6588


Coverage Determination and Redetermination Forms

To initiate the coverage review process or to initiate an appeal of a previously declined coverage review request, please use the resources below.

  PDF File Online Application
Coverage Review Request Form Medicare Prescription Drug Coverage Determination (PDF file) Submit a coverage determination request form online
Redetermination Request Form Coverage Redetermination Request form (PDF file) Submit a coverage redetermination request form online