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Y0055_MPC092567_Approved_M_10012025
Last Updated: 10/1/2025

What if my drug is not on the Formulary?

​If your drug is not included in the formulary (list of covered drugs), you should contact the Presbyterian Customer Service Center (customer service) and ask if your drug is covered.

Presbyterian Senior Care: 505-923-6060 or 1-800-797-5343  (TTY 711) Presbyterian Dual Plus: 505-923-7675 or 1-855-465-7737 (TTY 711) Hours: Available October 1 to March 31: 8 a.m. to 8 p.m., seven days a week (except holidays) and April 1 to September 30: 8 a.m. to 8 p.m., Monday to Friday (except holidays)

If you learn that our plan does not cover your drug, you have two options:

  1. You can ask customer service for a list of similar drugs that are covered by our plan. When you receive the list, show it to your provider and ask them to prescribe a similar drug that is covered by our plan.

  2. You can ask Presbyterian Senior Care (HMO) or Presbyterian Dual Plus (HMO D-SNP) to make an exception and cover your drug. A drug formulary exception can be requested by phone, fax, mail, or online.


How do I request a change?

Use one of the options below to submit a medication or reimbursement exception request. Send your request online at phs.org, or by phone or mail. The Presbyterian Pharmacy Services team will review your request.

Phone To request an exception, you or your appointed representative should call the Presbyterian Customer Service Center.

Presbyterian Senior Care: 505-923-6060 or 1-800-797-5343  (TTY 711) Presbyterian Dual Plus: 505-923-7675 or 1-855-465-7737 (TTY 711) Hours: Available October 1 to March 31: 8 a.m. to 8 p.m., seven days a week (except holidays) and April 1 to September 30: 8 a.m. to 8 p.m., Monday to Friday (except holidays)

Fax or Mail You, your provider or pharmacist can also fax or mail an exception request.


Form for Medicare Drug Coverage Determination Request - Updated 11/17/2022

Form for Presbyterian Dual Plus (HMO D-SNP) Drug Coverage Determination Request

Fax: 505-923-5540 Mail: PHP Pharmacy Department P.O. Box 27489 Albuquerque, NM 87125-7489


Medication or Reimbursement Exception Request

Form to Make a Pharmacy Reimbursement Claim

Mail completed form(s) with register receipts and other supporting documents to:

Capital Rx, Inc. Attn: Claims Dept. 9450 SW Gemini Dr., #87234 Beaverton, OR 97008

You can also email documents for processing to dmr@cap-rx.com.

For information on Appeals and Grievances, click here