Reminders: These may prevent you from having to submit a claim form
- Use your ID card when obtaining prescriptions at a pharmacy.
- Use a network pharmacy.
- Fill prescriptions for drugs on your approved drug list/formulary.
- Claims will be processed within 30 business days.
How to Submit a Paper Claim Reimbursement Form for Out-of-Network Pharmacies and Coordination of Benefits:
- Review the Dos and Don'ts.
- Download, print, and complete the Prescription Drug Claim Form.
- Attach receipts.
- Make copies of your submission and retain for records.
- Mail to the address indicated on claim form.
- Complete the prescription claim reimbursement form that corresponds with the RXBIN number on your ID card.
- NABP = National Association of Boards of Pharmacy number
- NDC = National Drug Code
- DAW = Dispense as Written (If a prescription is written for a brand name drug when a generic equivalent is available, you will pay a higher copay)
- DEA = Drug Enforcement Agency
- RXBIN = 004336
- Make a copy of prescription receipt and include with the claim form.
- If your plan has coordination of benefits (COB), you may submit a paper claim for consideration of your secondary benefit. Be sure to include primary claim payment information and EOB (explanation of benefits) to avoid delays in processing your claim.
NOTE: Claim form with expense documents must be furnished to Caremark no later than 18 months from the date that the services or supplies are provided to the participant."
- Do Not include Mail Service Order Form with your paper claim submission.
- Do Not send in a cash register receipt.
- Do Not send medical or dental claims.
Contact Customer Care if you have any questions regarding your claim(s).