Get Prescription Renewal Form - Optumrx

Filling out the PrescriPtion Renewal Form - OptumRx online can streamline the process of renewing your prescriptions. This guide will walk you through each section of the form, providing clear instructions to help you complete it easily.

Follow the steps to complete your prescription renewal form online.

1. Click the ‘Get Form’ button to access the form and view it in your document editor.
2. Complete the delivery information section by entering your last name, first name, middle initial, member ID number, delivery address, city, apartment number (if applicable), state, ZIP code, and phone number with area code.
3. Fill out the payment information section by checking the option that indicates whether you are enclosing a check payable to OptumRx or charging the payment to your credit card on file.
4. In the filling instructions section, mark the circle next to each prescription you wish to renew. If you are interested in automatic refills for your eligible maintenance medications, select the option under Hassle-Free FillSM (HFF).
5. Provide the prescription number, medication and strength, directions for use, quantity you desire, and the number of refills for each prescription you are ordering.
6. The prescribing physician must complete their part of the form by reviewing and updating the prescription information. They should enter the number of refills authorized and provide their signature along with the date.
7. Once the form is fully completed and signed, submit it by having the physician fax it to 1-800-491-7997 or mail it to P.O. Box 509075, San Diego, CA 92150.

Complete your prescription renewal form online today for a more efficient process.