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  • Prescriber Information Fax Completed Form To 1 ... - Express Scripts

Get Prescriber Information Fax Completed Form To 1 ... - Express Scripts

Prior Authorization Form Antidepressant SSRI Step Therapy This form is based on Express Scripts standard criteria and may not be applicable to all patients; certain plans and situations may require.

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To start, enter the pharmacy's fax number. Next, fill out the rest of the required details. You can also type a custom message or insert an electronic signature. Find the attachment space, then drag and drop a copy of your prescription.

Your doctor can fax this form to Express-Scripts at: 1-877-895-1900.

Your doctor can initiate the prior authorization process by calling Express Scripts toll-free at 800‑417‑8164 or by fax at 800‑357‑9577.

Go to Forms & Cards under Benefits in the top menu of the home page and select the appropriate form. your prescription to the address listed. appointment and ask your doctor to fax it to the number listed. You cannot fax your prescription to us, only your prescriber can.

You can also fill your 90-day prescriptions at a Walgreens or Duane Reade pharmacy. If you have refills remaining with your current home delivery pharmacy, in most cases, you don't need to get a new prescription. Your refills will automatically transfer to the Express Scripts Pharmacy.

Your provider can also fax your prescription to Express Scripts® Pharmacy — they can call (888) 327-9791 for faxing instructions. Be sure to give them your member ID number. (Only providers can fax prescriptions.)

Call 844-516-3323 to speak with a prescription benefit specialist or sign in at .Express-Scripts.com/StartHD and select “Transfer your retail prescriptions” to get started. We'll do the rest.

Please call us at 800.753. 2851 to submit a verbal prior authorization request if you are unable to use Electronic Prior Authorization. Prior Authorization criteria is available upon request.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232