Useful Forms
Request for Medicare Prescription Drug Coverage Determination Form
Use this form if you wish to request a coverage determination, including a request for tiering or formulary exception.
Appointing a Representative Form
If you wish to appoint someone to act on your behalf when requesting a coverage determination, use the Appointing a Representative Form. You can name a relative, friend, advocate, doctor, or anyone else to act for you. Some other persons may already by authorized under state law to act for you. If you want someone to act for you, then you and that person must sign and date this form.
Mail completed form to:
TEAMStar Part D
Attn: TEAMStar Part D Information
P.O. Box 8080
McKinney, TX 75070
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