Pharmacy Pricing Appeals

A pharmacy may submit a pricing appeal using the Pharmacy Appeal Form.

• Email the form.
  
• Fax to 330-230-9277. If a fax is sent, please include an email address. An email address is required for a response.

Download the Pharmacy Appeal Form.

• The pharmacy must provide invoices or wholesaler information demonstrating proof to acquisition cost.
• The initial appeal process is available for all prescription drugs or devices in the state in which a pharmacy alleges it did not receive its actual cost.

Pharmacy appeals must be submitted within 7 business days of the initial claim submitted for reimbursement. The appeal will be reviewed, and an e-mail response will be provided within 7 business days. Contact us at (330) 859-7364 with any questions.