The SilverScript Medicare Part D Appeals Process (Redetermination)


What is a SilverScript Medicare Part D Appeal?

If you disagree with a decision we make in response to your original request for a Coverage Determination, you have the right to ask us for a Redetermination by submitting an Appeal. An Appeal is the process of asking us to reconsider our initial Coverage Determination decision. There are additional levels of Medicare Part D Appeals available to you if you disagree with a Redetermination.


For doctors or other prescribers to request a Redetermination by electronic prior authorization (ePA) if your coverage determination was previously requested by ePA: Your provider should visit their local electronic health record (EHR) platform or dedicated ePA portal, such as covermymeds®, Surescripts®, or Novologix®.


To request a Redetermination by phone: Call toll-free, 1-866-235-5660, 24 hours a day, 7 days a week. TTY users should call 711.

To fax a written request for Redetermination: Fax toll-free: 1-855-633-7673.

To mail a written request for Redetermination: SilverScript Insurance Company
MC109 P.O. Box 52000
Phoenix, AZ 85072-2000


To submit your request electronically, use the Drug Search and Pricing Tool

Standard and Expedited Redetermination Requests


Standard Redetermination Request

We will make our decision on a standard request within 7 days of receipt.

Expedited Redetermination Request

You have the option to make an expedited request (one that requires a faster response) if you or your doctor or other prescriber believe your health could be seriously harmed by waiting up to 7 days for a decision. If your request to expedite is granted, we will give you a decision no later than 72 hours after we receive your request.

Note: If your doctor’s or other prescriber’s requests or supports your request for an expedited Redetermination and your doctor or other prescriber indicates that waiting for a standard decision could seriously harm your health or your ability to function, we will automatically give you an expedited request.


  • This chart provides an overview of the Appeals process
  • Your request
  • What you or your prescriber can do
  • What your plan will do
    • Your request
    • Reconsider an unfavorable Coverage Determination
    • What you or your prescriber can do
    • Submit an Appeal within 60 days from the date of the notice of the Coverage Determination asking us to reconsider our decision.
    • What your plan will do
    • Respond with a Redetermination based on our interpretation of how your plan benefits apply to your specific situation.
    • Your request
    • Reconsider an unfavorable Coverage Redetermination
    • What you or your prescriber can do
    • Request an Appeal conducted by an Independent Review Entity (IRE) not connected with your plan.
    • What your plan will do
    • We will abide by the final outcome of your IRE Appeal.
    • Your request
    • Appeal a Reconsideration Decision rendered by the Independent Review Entity (IRE)
    • What you or your prescriber can do
    • Submit a request for Reconsideration within 60 days from the date you received the written Redetermination notice from the IRE.
    • What your plan will do
    • We will abide by the final outcome of your Reconsideration by the IRE.

To file a Reconsideration Form by mail, send the form in writing to: Maximus Federal Services
C/O Part D Drug Appeals
3750 Monroe Ave, Suite 703
Pittsford, NY 14534-1302


To request a Reconsideration Form by phone:
To Fax a request for Reconsideration Form:

SilverScript Medicare Part D Appeals Process and Plan Performance

As a SilverScript member, you have the right to receive additional plan information from us in a way that works best for you, including:

  • Your plan's financial condition
  • The number of Appeals made by plan members
  • Your plan's Star Performance ratings–including how the plan has been rated by plan members and how it compares to other Medicare prescription drug plans.

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