Request Medicare Coverage Determination

Submit a Coverage Determination Request with MVP Health Care to ask for prescription drug coverage decisions, including exceptions or prior authorizations, securely online or by mail using the downloadable form.

Request Medicare Coverage Determination

Submit a Coverage Determination Request with MVP Health Care to ask for prescription drug coverage decisions, including exceptions or prior authorizations, securely online or by mail using the downloadable form.

Submit a Coverage Determination Request 

Please complete the form on this page and select “Submit” to make your request. All fields are required unless they say “optional.” We will send your information securely to protect your privacy. If you’d like to print a copy for your records, use your web browser’s “print” function.  

Note: Some requests may need a supporting statement from your prescriber. 

If you’d prefer to complete this form by hand, download a PDF of the Coverage Determination Request Form. Then follow the instructions on the form to return it by mail or fax.

Speak to a Representative

To shop for a plan, contact an MVP Medicare Advisor at 1-800-324-3899 (TTY 711)

For questions about your plan, contact the MVP Medicare Customer Care Center at 1-800-665-7924 (TTY 711). If you have an MVP DualAccess plan, call 1-866-954-1872 (TTY 711).

From April 1-September 30, reach us Monday-Friday, 8 am-8 pm. 

From October 1-March 31, reach us seven days a week, 8 am-8 pm.