Members

Prior Authorization form

Drug Prior Authorization Form (Adobe Acrobat Reader is needed to see this file)

direct member reimbursement form

Direct Member Reimbursement Form (Adobe Acrobat Reader is needed to see this file)

http://www.pharmavailotc.com (Click This Link for Mail-Order Prescriptions and Over-the Counter Medications and Supplies.)

MedSave Rx Formulary by Drug Name (Adobe Acrobat Reader is needed to see this file)
MedSave Rx Formulary by Disease or Condition (Adobe Acrobat Reader is needed to see this file)
MedSave RX Plan Information (Adobe Acrobat Reader is needed to see this file)
MedSave RX FAQ (Frequently Asked Questions (Adobe Acrobat Reader is needed to see this file)

 

www.ameripharminc.com (Click this link for mail order prescriptions)
www.pharmavailotc.com (Click this link for mail order prescriptions and OTC products & supplies)
www.walgreensmail.com (Click this link for mail order prescriptions)
www.usbioservices.com (Click this link for specialty prescriptions)