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Determination Request

Request for Medicare Prescription Drug Coverage Determination

A coverage decision is a decision that Alignment Health Plan makes about benefits and coverage or about the amount the plan will pay for medical services or drugs. An initial coverage decision about Part D drugs is called a "coverage determination."

Coverage Determination Online Form

Or Click the below link to download a PDF copy of the Coverage Determination Form.

Coverage Determination

This form may be sent to us by mail or fax:

Alignment Health Plan
Attn: Clinical Review Department
2900 Ames Crossing Road
Eagan, MN 55121

Fax Number:

You may also ask us for a coverage determination by phone toll-free at 1-844-227-7616, 24 hours a day, seven days a week. TTY users should call 711 or visit our website at