Request for Medicare Prescription Drug Coverage Determination
Coverage Determination Online Form
Or Click the below link to download a PDF copy of the Coverage Determination Form.
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
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 www.alignmenthealthplan.com.
Page last updated on 10/4/2019 | Y0141_20095EN