Forms

Caremark is Your Prescription Drug Administrator

These claim forms should be used when filing for reimbursement for a prescription drug or when using the mail-order program for services rendered on or after September 1, 2008.

• Prescription Drug Reimbursement Form (pdf)
• Prescription Drug Mail-Order Form (pdf)

If you need assistance in completing your prescription drug forms, call Caremark Customer Service at (888) 886-8490.