Once you are certain your pharmacy benefit includes a mail order
component, you can send your prescription to your Medco
mail order pharmacy one of three ways:
Have your physician fill out this fax form, and follow the instructions
to send it in to us.
Note: This fax form requires Adobe® Reader® to print.
If you need to download or install, click the icon below.
IMPORTANT: Only your physician may fax the completed form
Your doctor may also obtain fax forms and instructions directly by calling 1-888-EASYRX1 (1-888-327-9791). This number is for physicians only.
Please note: a special fax form is required in the state of Virginia. If you or
your doctor are located in Virginia, ask your doctor to obtain the correct form
by calling the number listed above.
Mail in a prescription your physician has written using our online
mail order form. To access our online form, click
here and simply follow the instructions on how to download,
print and mail in your completed home delivery form with any new
Find out if your plan sponsor allows you the flexibility to request
new prescriptions right here at our website, by clicking the register
now button below.
To use this service, you must have previously discussed your
prescription request with your prescriber. Your prescriber must
also indicate approval before we will contact him/her. Please
note that controlled substances including narcotics are not eligible
for this service. If you would like us to request a prescription
for you, you may do so by completing our online request form.
Once completed, we will submit your request to the prescriber
you indicate. Please note that your request will not be filled
or shipped until your physician indicates approval of this request
by submitting a prescription to us.