Walk-In Services

As a member, you are entitled to file a grievance if you are dissatisfied with our service, plan, or pharmacies. You are also entitled to appeal a denial of payment, eligibility or other decision. The following links provide the information needed to complete and file grievances and appeals, prescription drug coverage determination request or representative forms:

• Reference Guide for Filing an Appeal
• Reference Guide for Filing a Grievance
• Request for Medicare Prescription Drug Determination
• Request for Redetermination of Prescription Drug Denial

For additional information on coverage determinations (including exceptions), grievances and appeals processes, please refer to the 2023 Evidence of Coverage (Option 1) or the 2023 Evidence of Coverage (Option 3).

As a Medicare-approved prescription drug plan, we must establish procedures for making timely organization determinations (coverage decisions) regarding the benefits an enrollee is entitled to receive under a prescription drug plan. You may ask us to make a coverage decision about a drug, but only an expedited request can be made by calling. To request an expedited coverage decision about your Part D drug, please contact 877.234.3853 (toll-free) or 711 (TTY).

Standard coverage decisions must be in writing. Please send these requests to:

Prime Therapeutics

Attention: PA Department
2900 Ames Crossing Road,
Eagan, Minnesota 55121
Fax: 1.800.693.6703

Please contact us with any questions at 877.234.3853(TTY 800.779.6961), Monday through Friday, from 8 am to 8 pm

LinkCMS Complaint Form: Submit your feedback about your health plan or prescription drug plan directly to Medicare.

Appointing a Representative

If you want a friend, relative, your doctor or other provider, or other person to be your representative, you will need to complete the Appointment of Representative form. This will give that person the ability to act on your behalf. The form must be signed by you and by the person who you would like to act on your behalf. You must give us a copy of the signed form.

Obtaining Data on Exceptions, Appeals and Grievances

Members of SecureRx PDP may receive a description of the plans’ total number of exceptions, appeals and grievances received and how these cases were resolved. Contact SecureRx PDP by phone or in writing.

Disenrollment is the process to end your membership in our plan. Your group administrator should provide you with information on when you can enroll and disenroll from your Medicare Part D prescription drug plan. 

You can voluntarily disenroll:

• You may end your membership during your Employer’s enrollment period.  Since your plan is an employer group plan, you must follow the enrollment periods that are established by your group administrator. If your employer group allows you to select a new Medicare Part D prescription drug plan during their annual enrollment period, your coverage with our plan will end when your coverage with the new plan begins.
• In certain situations, you may be eligible to end your membership during a Special Enrollment Period. For example, if you move out of the service area, if you have Medicaid, if you are eligible for “Extra Help” with paying for your Medicare prescriptions, or if we violate our contract with you. For a full list of situations or to find out if you are eligible for a Special Enrollment Period, call Medicare at 1-800-MEDICARE (800.633.4227). If you want to switch from one of our plans including prescription drug coverage to original Medicare, which does not have a prescription drug plan, contact Avalon Secure Rx Customer Service and ask to be disenrolled. Or, call Medicare at 800.633.4227, 24 hours a day, seven days a week. TTY users should call 877.486.2048.
• Note: If you disenroll from Medicare prescription drug coverage and do not have creditable prescription drug coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later. Creditable coverage means coverage that is expected to pay at least as much as Medicare’s standard prescription drug coverage, on average.

Involuntary disenrollment:

We may end your coverage for any of the following reasons:

• If you no longer have Medicare part A or part B (or both).
• If you move out of our service area, unless your employer group administrator allow your coverage with our plan to continue.
• If you are away from our service area for more than twelve months.
  • If you move or take a long trip, call Member Services to find out if the place you are moving or traveling to is in our plan’s service area.
  • If you become incarcerated (go to prison).
  • If you are no longer a United States citizen or lawfully present in the United States.
  • If you lie about or withhold information about other insurance you have that provides prescription drug coverage.
• If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
• If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care to you and other Members in our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
• If you let someone else use your membership card to get prescription drugs. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
  • If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General.
• If you are required to pay the extra Part D amount because of your income and you do not pay it, Medicare will disenroll you from our plan and you will lose prescription drug coverage.