Request for Medicare Prescription Drug Determination Request Form

Request form for Members may be found HERE 

The Prescription Drug Determination Request form is optional and not necessary to request a drug determination. Prescribers can request an exception or expedited exception by writing directly to us at 12900 Park Plaza Drive., MS-7125, Cerritos CA 90703 or contacting our CareMore Member Services Department at our toll free number 1-800-499-2793 (TTY 1-800-577-5586), 8 a.m. to 8 p.m., PST, 7 days a week.