Medi-Pak Advantage (PFFS) Forms


If your medication requires Prior Authorization, you may print the appropriate form and take it to your doctor to submit.

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To request a coverage determination or redetermination, please print and complete the appropriate form and fax to CVS Caremark Appeals at 1-866-884-9475 or mail it to CVS Caremark Appeals at PO Box 52000, Phoenix, AZ, 85072-2000. If you have questions regarding the prior authorization process, please call 1-866-494-6699.


If you would like to designate someone to speak on your behalf, please print and complete the appropriate form and mail to Medi-Pak Rx (PDP) Privacy Office, P.O. Box 3835, Scranton, PA 18505. If you have questions regarding the designation process, please call 1-877-233-7022.


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