Commonwealth Care Alliance

Senior Care Options Program (HMO SNP)

Pharmacy » Exceptions, Appeals & Grievances » Part D Appeals

Part D Appeals

What is an appeal?

An appeal is any of the procedures that deal with the review of an unfavorable coverage determination. You would file an appeal if you want us to reconsider and change a decision we have made about what Part D prescription drug benefits are covered for you or what we will pay for a prescription drug.

Making an appeal

You, your physician, or your appointed representative may file an appeal in the following ways:

Telephone: 1-866-610-2273 (TTY 711)

Fax: 1-617-426-1311

Mail: Commonwealth Care Alliance
Member Services
30 Winter Street
Boston, MA 02108

You may also utilize your MassHealth appeal rights
You may request a fair hearing from MassHealth no later than 30 calendar days from the date you received your written denial notice from Commonwealth Care Alliance. The request must contain:

  • Your name
  • Your address and phone number
  • Your MassHealth ID number or Social Security number
  • Your reason for appeal
  • If you would like your hearing to be scheduled as soon as possible
  • If you need an interpreter to be provided

If you would like to name a representative to appeal on your behalf, the request must be signed and sent via mail or fax to:

Executive Office of Health and Human Services
Board of Hearings
100 Hancock Street, 6th Floor
Quincy, MA 02171

Fax: (617) 847-1204

Please keep one copy of the fair hearing request for your information.

If you do not agree with the fair hearing decision, you will have further appeal rights under MassHealth. You will be notified of those appeal rights if this happens.

Last Updated 07/29/2013