New Insurance Instructions for Prescription Medications

This form is to be used for the FIRST time you are ordering maintenance prescriptions. Be sure to have your doctor prescribe three months of the medication you are ordering. You will mail the prescription with this form. After you establish the new prescription at Caremark, you can order refills via their web site www.caremark.com or call them at 1-888-202-1654.

Caremark Form Page 1

Caremark Form Page 2