How do I request a coverage determination or medical exception for a drug?

You, your authorized representative, or your prescribing doctor can ask for a coverage determination.

  • Mail us a Coverage Determination Request Form to:

    Simplete
    3310 Fields South Drive
    Champaign, IL 61822

  • Call us at (800) 851-3379, option 4, Monday through Friday, 8 a.m. to 5 p.m.