The following prescription drug forms are available as PDF files. Just click on a form to download it. Have your doctor fax in completed forms. Your doctor can submit online or call 1-855-457-0407. You may need to install a PDF reader program to view these files. One option is Adobe Reader; this can be downloaded free of charge at Adobe's site.
Prescription Drug Forms
Find a Doctor or Hospital
Use our Provider Finder® to search for doctors and other health care providers near you.
Contact Us
- 1-888-657-6061
(TTY: 711) - 8 a.m. to 5 p.m. Central Time, Monday through Friday
- Contact Us