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 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.

  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


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:

Initial Clinical Coverage Reviews
Use this contact information if you need a coverage decision about a restriction on a specific medication.
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:
1.877.328.9799
Mail the appropriate
form to:
Express Scripts
Attn: Medicare Reviews
PO Box 66571
St. Louis, MO 63166-6571

Administrative Coverage Reviews and Appeals
Use this contact information if you need a decision about whether or not a medication is covered and at what cost-sharing amount.
Phone (toll-free): 1.800.413.1328
Mon. through Fri., 8:00 a.m. - 6:00 p.m. Central 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 Administrative Appeals
PO Box 66587
St. Louis, MO 63166-6587

Clinical Appeals
Use this information if you need to file an appeal about a restriction on a specific medication.
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:
1.877.852.4070
Mail the appropriate
form to:
Express Scripts
Attn: Medicare Clinical Appeals
PO Box 66588
St. Louis, MO 63166-6588