Confirm the exact product or service National contact — confirm product and location
Mailing address
Not researched for this route
Current provider page lists the pharmacy help desk and uses this customer-care number for UM criteria, copays/formulary tiers and other pharmaceutical-management questions. Puerto Rico pharmacies calling about MCS claims have a distinct route. No general PA fax or reimbursement fax is inferred from this help-desk entry.
Confirm the exact product or service National contact — confirm product and location
Mailing address
Not researched for this route
Current provider page links General Prior Authorization - 33419. The form title is Coverage determination request form and its EOC entry is Medically-Accepted Indication Prior Authorization. Its printed contact is 800-361-4542 / fax 866-414-3453. This does not establish that the same form applies to every BIN, plan or medication-specific exception. Current form footer is copyright 2024 / E12024 despite a 2020 filename. PromptPA and other electronic methods are linked separately on the provider page.
MAC concerns for pharmacies located in Puerto Rico calling on behalf of MCS claims; not a universal MAC appeal or claim-submission inbox.
Published hours
Not published in this record
Product, plan and location
Confirm the exact product or service Puerto Rico
Mailing address
Not researched for this route
Both the telephone and MAC email are expressly scoped to Puerto Rico pharmacies and MCS claims. The provider page directs other MAC appeals to the pharmacy portal.
Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.
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Call preparation · editorial guide
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Separate pharmacy-benefit requests from drugs billed under the medical benefit. The PBM and the insurer may use different contacts.
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PBM name and the pharmacy identifiers on the card
Drug, formulation and prescription information
Prescriber details and previous review reference
Questions to resolve
Is this processed under the medical or pharmacy benefit?
What is the correct review and submission channel?
Is there a separate specialty pharmacy or appeal team?
This is a general administrative checklist, not payer policy or advice about a particular patient. Confirm the current plan instructions.
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