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Pharmacy Forms |
Pharmacy Forms & Notices
Here’s a list of pharmacy documents and forms you may need when using your Medicare Part D benefit. If you have questions about these items, please contact Member Services. We’re here to help.
- Prescription Drug Claim Form-English (PDF)
- Prescription Drug Claim Form-Spanish (PDF)
- Express Scripts Mail Order Form-English (PDF) - Coming in December 2023
- Express Scripts Mail Order Form-Spanish (PDF) - Coming in December 2023
If you have questions, please contact Member Services.