How to Ask us to Cover a Prescription Drug
You may ask us to cover a prescription drug for you.
- Please complete the “REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION FORM” Click Here to Download
- Be sure to include your personal information such as your name and member number from the Brand New Day Identification card.
- Check the box that best describes the type of coverage request you are asking for.
- If you want to be reimbursed for a covered prescription drug that you have paid for, check that box and provide copies of proof of how much you paid.
- You may need a supporting statement from your prescribing doctor. Your doctor may write out an explanation or complete the section of the “REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION FORM” titled “Supporting Information”.
- Mail or fax your completed form to:Address:
Brand New Day C/O MedImpact
10680 Treena Street Suite 500
San Diego, CA 92131
- We will make a decision within 72 hours of receiving your request or 24 hours if your request was for a fast decision.
- You may also call us at: 866-255-4795 TTY: 866-321-5955