102 CVS Caremark will treat the claim as a Post-Service Claim set forth in the medical benefit claims provisions above. Any prescription drug claim CVS Caremark receives more than one year after the date of purchase will be denied as untimely. Specialty Medications Specialty Medications can be filled by using only CVS Caremark Specialty Pharmacy Services. Claims for Specialty Medications are treated as Pre-Service Claims because you must get prior authorization as a condition of coverage. If you are prescribed a Specialty Medication, or if your pharmacist tells you that an item you are requesting is a Specialty Medication, you must call CaremarkConnect  toll-free at 800-237-2767. When notified, CVS Caremark will contact your physician directly to obtain clinical information needed to perform a prior authorization review, and you will not have to complete a written claim form. CVS Caremark Specialty Pharmacy Services include a program called ACSF, which means Advanced Control Specialty Formulary. With ACSF, in addition to the required Medical Necessity review, Specialty Medications will also be reviewed to determine whether a preferred alternative exists that should be tried first. If an alternative is available, it will be discussed with your physician and the script changed. This is part of the prior authorization process which will be transparent to you. CVS Caremark will notify you in writing of its determination on your claim for coverage of a Specialty Medication within a reasonable period of time, but no later than 15 calendar days after it receives notification of the claim. This period may be extended by one 15-day period, if special circumstances beyond CVS Caremark’s control require that additional time is needed to process your claim. If an extension is needed, CVS Caremark will notify you in writing before the expiration of the initial 15- day period of the circumstances requiring an extension and the date by which it expects to reach a decision. If the extension is required because additional information is needed from you to decide the claim, the notice of extension will specifically describe the information that is needed from you, and you will be given at least 45 days from your receipt of the notice within which to provide the information. If your claim for a Specialty Medication is an Urgent Claim, you will be notified of CVS Caremark’s determination more quickly. The definition of an Urgent Claim is as set forth in the health benefit claims section above. For Urgent Claims for Specialty Medication, CVS Caremark will notify you of its determination as soon as possible, taking into account the medical exigencies, but no later than 72 hours after you first call CVS Caremark about the prescription for the Specialty Medication, unless you or your physician fail to provide sufficient information to make the determination, in which case you will be notified within 24 hours of the information that is needed. The determination will then be made no more than 24 hours after CVS Caremark receives the information. Appeals of Prescription Drug Claims Denied by CVS Caremark A. First Level Appeal If you disagree with a determination made by CVS Caremark on any prescription drug claim, you must first submit a request for appeal by contacting CVS Caremark customer care at 800-282-8503 within 180 days of receipt of your denial notice. You should state the reason why you believe your appeal should be approved and include any information supporting your appeal. First level appeals received more than 180 days after receipt of the denial or adverse determination of the claim will be denied as untimely.