Prescription Drug Order Information

www.medco.com

If you wish to order prescriptions online please go to www.medco.com to register and order.

Getting Started with Mail Order

Answers to frequently asked questions about Medco Mail Order.

Mail Order Form

Use this form to order medication through our mail order service (MEDCO BY MAIL).

If you need additional information or assistance, visit www.medco.com/coventry or call Pharmacy Customer Service at the phone number on your ID card

Reimbursement Forms

Coordination of Benefits Direct Claim Form

Use this form to submit claims under Coordination of Benefit Rules.

Vaccine & Administration (Injection) Claim Form

This claim form is for reimbursement of covered Part D vaccines and their administration (injection). Please consult your Evidence of Coverage for specific coverage information.

Additional Information

Medco Health, Allergy & Medication Questionnaire (HMQ)

Your answers to the following questions will help protect you against potentially harmful drug interactions and side effects. Medco will alert your pharmacist about possible drug allergies and interactions that can be harmful. To best serve you, Medco needs you to answer the questions in this questionnaire.

Prescription Drug Benefits

Find more prescription drug benefit information and forms, including coverage determination forms and prior authorization fax forms.