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Drug Forms

Caremark Claim Form

Use the Caremark Prescription Drug Claim Form to file claims for covered prescriptions for which you paid 100 percent, for covered prescriptions you received without showing your ID card, and for covered prescriptions you received from a non-participating pharmacy. (This form is for members who have prescription coverage with Caremark through PAI.)

Caremark Mail Service Pharmacy Program

Members should use the Caremark Prescription Drug Mail Order Form to order up to 90-day supplies of their prescriptions through Caremark's Mail Service prescription drug program. On behalf of PAI, Caremark assists in the administration of the program. Caremark is an independent company that provides pharmacy benefits management. Please Note: Not all of our members have mail-service prescription drug benefits. They should check their health plan details or ask their benefits coordinators to make sure they have mail-service benefits.