Get Optumrx Mail Order Form

The Optumrx Mail Order Form allows users to conveniently order their medications online. This guide provides step-by-step instructions for completing the form, ensuring all necessary information is submitted correctly.

Follow the steps to complete your order form effectively.

1. Click ‘Get Form’ button to obtain the form and open it.
2. Fill in the member and physician information section. Ensure to use black or blue ink. Include your Member ID Number, last name, first name, middle initial, delivery address, city, state, ZIP code, phone number, date of birth, gender, and email.
3. Complete the health history section. Indicate any known medication allergies and existing health conditions by checking the appropriate boxes or writing in additional details as required.
4. Proceed to the payment and shipping information section. Select your preferred payment method, whether by credit card or check. Provide your credit card number and expiration date, and include your signature confirming the payment authorization.
5. Review all the information filled out on the form for accuracy. Check that all required fields are completed.
6. Mail the completed order form along with any new prescriptions to OptumRx, P.O. Box 2975, Mission, KS 66201. Ensure that prescriptions are not attached with staples or tape.
7. After mailing the form, keep track of your order. Expect delivery of new prescriptions within about 10 business days, and completed refill orders should arrive within about 7 business days.

Start completing your Optumrx Mail Order Form online today to ensure your medications are delivered to your door.