Who May Make a Request
You or your prescriber may ask us for a coverage determination. If you want another individual (such as a family member or friend) to make a request for you, that individual must be your appointed representative. For more information on appointing a representative contact us, Granite Alliance Insurance Company (PDP), at 1-855-586-2573 (TTY users call 711), or visit mygraniterx.com. You may also contact Medicare at 1-800-MEDICARE (1-800-633-4227), TTY users 1-877-486-2048, 24 hours/7 Days a week.
Note: Fields marked with a single asterisk ( * ) are required.