Part D Coverage Determinations

What is an exception?

An exception is a type of coverage decision that, if approved, allows you to get a drug that is not on Alterwood Advantage’s formulary (a formulary exception), or get a non-preferred drug at a lower cost-sharing level (a tiering exception). You may also request an exception if your Alterwood Advantage requires you to try another drug before receiving the drug you are requesting, or the plan limits the quantity or dosage of the drug you are requesting (a formulary exception).

Since Alterwood Advantage Dual Secure’s formulary has one (1) tier, tiering exceptions are not applicable.

Where can you or your prescriber obtain a coverage decision or exception?

You or your prescriber may contact us to request a coverage decision or exception using the information below.

MethodPart D Coverage Decision and Exception Requests
Call667-261-8050 or 1-866-267-3144 toll-free.
Calls to this number are free. We are available 24 hours a day, seven (7) days a week.
Calls to this number are free. We are available 24 hours a day, seven (7) days a week.
Attn: PA Department
2181 E. Aurora Rd., Suite 201
Twinsburg, OH 440807
(Select Member)

May I request for a Coverage Determination or Exception (i.e., prior authorization) and redetermination (i.e., Part D appeal) before 1/1/2022?

No. Members are eligible for up to a one-month transition drug supply within 90 days of enrollment in Alterwood Advantage. Please review to Transition Policy here.

If you have any questions regarding the coverage determination and/or redetermination process, please contact us at 667-261-8050 or 1-866-267-3144 toll-free. TTY: 711. Calls to this number are free. We will be available 24 hours a day, seven (7) days a week beginning 1/1/2022.