Learn about your copays, deductibles
and benefits of your prescription
Mail order is an easy and convenient way to receive your prescriptions, wherever you are.
Learn more about specialty medications and how they are managed for your
Whether you need to show your prescription ID card to the pharmacist or you want to see your prescription history, your Member Portal and app will help you better manage your pharmacy benefits.
Use these online tools to:
Search "Elixir Rx Solutions" in your app store and download the app to your mobile device today.
Select the link below to download the Designation of Authorized Party Form in your preferred language:
Click here to download the HIPAA Consent Form
Click here to download the HIPAA Release Form
Click here to download the HIPAA Revoke Form
Click here to download the Prescription Request Form
Click here to download the Prescription Request Form Spanish
You may be able to complete your reimbursement request in your Member Portal account. To learn more, log in to your Member Portal account.
Member Reimbursement Form
Member Reimbursement Form Spanish
Member Reimbursement Form for BIN 800004
Guide to Requesting Reimbursement for OTC COVID-19 Tests
Click here to download the Facts about Generics flyer in English.
Click here to download the Facts about Generics flyer in Spanish.
Member Rights and Responsibilities
Pharmacy Rights and Responsibilities