Use this form to ask Capital Rx for a coverage determination, exception, or redetermination (appeal) for a drug that will be obtained under the pharmacy benefit.

Providers: Instead of using this form, please submit requests online through CoverMyMeds at https://www.covermymeds.health/. 

You can also request a coverage determination, exception, or redetermination (appeal) through phone, via mail, or fax by sending this form and any additional information to:

Address:
Capital Rx
Attention Prior Authorization
9450 SW Gemini Dr., #87234
Beaverton, OR 97008

Phone Number: (833) 502-3340 
TTY Users Call: 711
Fax Number: (833) 434-0563