You can ask Community HealthFirst to make an exception to our coverage rules.
- You can ask us to cover your drug even if it is not on our formulary.
- You can ask us to waive restrictions or limits on your drug. For example, quantity limits or step therapy restrictions.
- You can use our online formulary search tool to see if a drug has any restrictions.
Requesting an exception
- You can submit a request for a coverage determination review by calling Customer Service between 8 a.m. and 8 p.m., 7 days a week.
- You can submit a request for a coverage determination review by sending in a Coverage Determination Request form.
- You will need Adobe Acrobat Reader to view the PDF documents on this website. Download Adobe Acrobat Reader for free.
- You can submit a request for redetermination by sending in a Redetermination Request form (PDF) or submitting an online form.
We must make our decision within 72 hours of getting your prescribing physician’s supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 24 hours after we get your prescribing physician’s supporting statement.
Contact information for Prescription Drug Coverage Determination and Exception Requests
- Call us: Prospective Members: 1-800-944-1247 | Current Members: 1-800-942-0247 | TTY Relay: Dial 7-1-1 | Hours: 8 a.m. to 8 p.m., 7 days a week
- Fax us at 1-877-251-5896 or 1-800-652-7050
- Send written requests to:
Express Scripts, Inc
Attn: Prior Authorization – Part D
Mail Route B401-03
8640 Evans Road
St. Louis, MO 63134