Caremark Forms

Rx Claim Form (for groups with a separate Rx benefit co-pay)

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.

Prescription Drug Claim Form

Prescription Drug Card Brochure 

Caremark 2012 Preferred Drug List

Mail Service Pharmacy Program Brochure

Caremark Mail Service Order Form

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