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Part D Forms

Part D Formularies
Prescription Drug Plan

Learn more about our Appeals request

Redetermination form

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Request for Redetermination of Medicare Prescription Drug Denial

Reconsideration Form

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Request for Reconsideration of Medicare Prescription Drug Denial

Part D late enrollment penalty reconsideration

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Part D late enrollment penalty reconsideration request

Complete and send your form to:

Fax
787-200-2858 or 1-866-763-9097

Write
MCS Advantage, Inc.
Attention: Pharmacy Department
PO Box 191720
San Juan, PR 00919-1720

For assistance on how to complete these forms, you may contact our Customer Service Call Center at 787.620.2530 (Metro), 1.866.627.8183 (Toll Free) o TTY 1.866.627.8182 (Telephone for persons with hearing or speech impairment) Monday through Sunday from 8:00 a.m. to 8:00 p.m.

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