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. If the Pharmacy submits an incomplete initial appeal, the pharmacy will be notified within 5 business days of the information needed to complete the initial appeal and to initiate the review. The pharmacy may respond within 5 business days of receipt of the notice outlining the requested information. If the pharmacy fails to provide the requested information within 5 business days of receipt of the notice, the initial appeal may be denied.

Contact us at (330) 859-7364 with any questions.