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Reimbursement Policy

Reimbursement Policy - Drugs

What is a Payment Determination or reimbursement?

A payment determination is any determination (i.e., an approval or denial) made by MCS, with respect to whether reimburse you for the money or part of the money you already paid for a medication. That is commonly known as a Direct Member Reimbursement (DMR).

How can you request a Payment Determination?

You or your representative should mail your written request to the address below:

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

If you need information or help, you can call us at:

Toll Free: 1-866-627-8183
TTY: 1-866-627-8182
(Our service hours are Monday to Sunday from 8:00 a.m. at 8:00 p.m. from October 1 to March 31. Our hours of operation from April 1 to September 30 are Monday through Friday 8:00 a.m. to 8:00 p.m. and Saturday from 8:00 a.m. to 4:30 p.m.)

Reimbursement Requests (about your Part D prescription drugs)

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Direct Member Reimbursement Form 2025

Complete and send your form to:

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

FAX
1-866-763-9097

CALL
Our service hours are Monday to Sunday from 8:00 a.m. at 8:00 p.m. from October 1 to March 31. Our hours of operation from April 1 to September 30 are Monday through Friday 8:00 a.m. to 8:00 p.m. and Saturday from 8:00 a.m. to 4:30 p.m.

Toll Free: 1-866-627-8183
TTY: 1-866-627-8182
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