Request for Medicare prescription drug coverage determination
How to contact us when you are asking for a coverage decision about your Part D prescription drugs:
Fill out the Request for Medicare Prescription Drug Coverage Determination form (PDF)Opens a new window.
Fax, expedited: 1-855-825-2712
 Fax, standard: 1-855-825-2711
 Call us: 1-888-978-0862 (TTY/TDD 711), 24 hours a day, 7 days a week
 Write us:
 First Choice VIP Care Plus
 Attn: Pharmacy Prior Authorization/Member Prescription Coverage Determination
 PerformRx
 200 Stevens Drive
 Philadelphia, PA 19113
H8213_001_WEB_318369 _Approved_11132018