Caremark Forms


Caremark 2010 Preferred Drug List

Prescription Drug Claim form

If your Medical plan entitles you to pay a co-pay at the point of purchase and your prescription was not filed directly to Caremark by the pharmacy, use this form to submit for payment.

If your Medical plan entitles you to a discount at the point of purchase, and you file your receipts to PAI for reimbursement, please use the Medical Claim form located in the Claim Forms section of this web site.

Please see your Summary Plan Description if you have questions as to which plan is associated with your group.


Mail Service Pharmacy Program Brochure

Mail Service Order Form 

Prescription Drug Card Brochure  



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