Prescription Drug Order Information

www.medco.com

If you wish to order prescriptions online please go to www.medco.com to register and order.

Getting Started with Mail Order

Answers to frequently asked questions about Medco Mail Order.

Mail Order Form

With the mail order pharmacy service through Medco, you can arrange to have your maintenance drugs mailed to you each month for as long as your doctor’s prescription is valid.  Use this form to order medication through our mail order service (MEDCO BY MAIL).  If you need additional information or assistance call Pharmacy Customer Service at the phone number on your ID card.

Reimbursement Forms

Prescription Drug Claim Form

Request reimbursement for prescription drugs by completing this form.

Vaccine & Administration (Injection) Claim Form

This claim form is for reimbursement of covered Part D vaccines and their administration (injection). Please consult your Evidence of Coverage for specific coverage information.

Coverage Determination Forms

Request for Medicare Prescription Drug Coverage Determination Form

• Download and print PDF to submit - A request for a standard coverage determination can be made in writing and faxed to (800) 639-9158 or mailed to Coventry Health Care Coverage Determinations, P.O. Box 7773, London, KY 40742 

• Submit request online

• A request for an expedited coverage determination can be made by calling (800) 551-2694 or TTY 711 Telecommunications Relay Service for the hearing or speech impaired

Request for Appeal/Redetermination of Medicare Prescription Drug Denial

• Download and print PDF to submit - A request for a coverage redetermination can be made in writing and faxed to (800) 535-4047 or mailed to Coventry Health Care Coverage Redeterminations, P.O. Box 7773, London, KY 40742  

• Submit request online

• A request for an expedited coverage redetermination can be made by calling (800) 536-6767 or TTY 711 Telecommunications Relay Service for the hearing or speech impaired

Appeals and Grievances

Locate additional information about appeals and grievances.

Additional Information

Health, Allergy & Medication Questionnaire (HMQ)

Your answers to the following questions will help protect you against potentially harmful drug interactions and side effects. Medco will alert your pharmacist about possible drug allergies and interactions that can be harmful. To best serve you, Medco needs you to answer the questions in this questionnaire.

Prescription Drug Benefits

Find more prescription drug benefit information and forms, including prior authorization and step therapy fax forms.