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   CoventryOne Prescription Benefits » Caremark Rx Forms
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Note: Not all employer groups offer prescription benefits as part of health care coverage. Please check with your employer to verify whether you have prescription benefit coverage and at what level. If you do not have prescription benefits, you will not be able to use the Caremark.com feature below. In order to use the Mail Order Form below, your employer must offer you the option to receive select prescription drugs by mail.

If you order prescriptions through mail order, the Caremark customer service department will be able to assist you in tracking your prescription. You can contact the Caremark number at (800) 378-7040 or access the system via the Internet at http://www.caremark.com. You can use the mail order form below to order prescriptions via mail. You can download, view, and print the document(s) using Adobe Acrobat Reader. Acrobat Reader is free and can be downloaded from http://www.adobe.com/products/acrobat/readstep2.html

If you have any questions regarding mail order, please visit the Frequently Asked Questions section under the Prescription Benefits.

With all other issues, the member will need to contact our Member Service Department for more information using the phone number listed on the back of their member ID card.

Caremark Mail Order Form - PDF(188 KB)

Caremark Prescription Reimbursement Form - PDF(135 KB)



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