Coverage Determination Appeal

You may appeal a coverage determination decision by contacting our Pharmacy Appeals department. Please complete a medication appeal request:

• Online: Complete our online Request for Redetermination of Medicare Prescription Drug Denial (Appeal) form.
• Fax: Complete an appeal of coverage determination request (PDF) and fax it to 1-866-388-1766.
• Mail: Complete an appeal of coverage determination request (PDF) and send it to:

'Ohana Health Plan
Attn: Pharmacy Appeals Department
PO Box 31398
Tampa, FL 33631-3398