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  • Optumrx Reimbursement Form

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PRESCRIPTION REIMBURSEMENT REQUEST FORM Use this form to request reimbursement for covered medications purchased at retail cost. Complete one form per member. Please print clearly. Additional information.

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Contact support

To return a product, please contact the Optum Store customer care team by phone at (855) 946-4463 or by email at support@store.optum.com. The care team will provide you with a free return shipping label and walk you through the return process.

Send completed form with pharmacy receipt(s) to: OptumRx Claims Department, P.O. Box 650334, Dallas, TX 75265-0334 Note: Cash and credit card receipts are not proof of purchase. Incomplete forms may be returned and delay reimbursement. Reimbursement is not guaranteed.

How does OptumRx home delivery work? Order up to a 90-day supply of medications you take regularly. Submit your order online, through the app, by phone, or mail. OptumRx fills your order, ships it to you, and lets you know when to expect your delivery.

Choose between OptumRx home delivery or at nearly 9,700 CVS Pharmacy locations. Your doctor can send an electronic prescription. Register at optumrx.com. Bring in your prescriptions or empty prescription bottles and the pharmacist will do the rest.

OptumRx is an affiliate of UnitedHealthcare Insurance Company.

6800 W 115th St, Suite 600 Overland Park, KS 66211-9838 NCPDP: 1718634 Call 1-800-791-7658 – Provide a verbal prescription directly to an Optum Rx provider dedicated pharmacist. Fax 1-800-491-7997 – Send a complete prescription using the Physician Fax Form.

In addition, beneficiaries are responsible for 100% of the prescription cost until an annual $50 individual or $100 family deductible is satisfied.

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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