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 Service Order Form

With the mail order pharmacy service through Medco, you can arrange to have your maintenance drugs mailed to you each month for as long as your doctor’s prescription is valid.  Use this form to order medication through our mail order service (MEDCO BY MAIL).  If you need additional information or assistance call Pharmacy Customer Service at the phone number on your ID card.

Reimbursement Forms

Prescription Drug Claim Form

Request reimbursement for prescription drugs by completing this form.

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 Forms

Exception - Medicare Prescription Drug Coverage Determination Form

Under the Medicare Advantage Part D (MA-PD) prescription drug benefit program, a MA-PD plan beneficiary can request a coverage determination, including a request for a tiering or formulary exception.