Prescription Claim Form (PDF) Prescription Mail Service Order Form (PDF) If your policy has a mail-order drug benefit, use this form to order new and/or refill mail service prescriptions.
2013 Formulary Two (formerly called Complete Care) (PDF) 2013 Standard Formulary (PDF) 2013 Standard Preferred Drug List (PDF) 2013 Value Formulary (PDF) 2013 Value Formulary Prefered Drug List (PDF) Maintenance Drugs (PDF) Medications considered to be necessary for long periods of time.Prior Authorization List (PDF) Medications that require prior approval. For authorization, call 1-877-433-2973.