Javascript is required to load this page.
Page Loaded
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
Powered by Qualtrics