2024 Medicare Part D appeals and grievances

Appeals and grievances 

Requesting a Part D Appeal or Grievance (pdf)

If you would like to file an appeal or grievance contact us:

Phone: 888-609-0692

Fax: 617-509-4232

Mailing address:
Harvard Pilgrim Health Care
Appeals & Grievances
P.O. Box 328
Canton, MA 02021

Medicare Prescription Drug Redetermination Request Form (Word doc)

Level 2 appeals

If we have denied your prescription drug appeal, the next step is to request a reconsideration by an Independent Review Organization. The following form contains the information you will need to make this request:

Medicare Part D Reconsideration Form (pdf)