Mail Service How to use your mail Anthem Rx mail service service pharmacy benefit pharmacy benefits Placing first time orders: If you regularly use any maintenance 1. Contact your physician for a new medication for hormone replacement or a prescription written for your condition such as asthma, diabetes, high maximum allowable days' supply. blood pressure or arthritis, you'll 2. Complete the enclosed easy order appreciate the convenience and savings of form. 3. Send the original prescription, the having your prescriptions filled by the completed order form and appropriate Anthem Rx mail service pharmacy. copayment in the envelope provided. Anthem Rx is a state-of-the-art pharmacy Remember: Always have your physician service that can accommodate 8,000 write your maintenance prescriptions for prescriptions each day. the maximum allowable days' supply for your mail service benefit. Transferring a prescription from a retail pharmacy: Make fewer trips to the 1. Have your prescription label(s) and pharmacy credit card (MasterCard, Visa or Ordering maintenance medications Discover Card) ready. through Anthem Rx eliminates monthly 2. Call this special toll-free number, trips to the pharmacy because your doctor can write your prescriptions for your (888) 61 3-6091, Monday through Friday, 8 a.m. to 6 p.m. Eastern time. maximum allowable days' supply. (90 days) Your prescriptions can then be 3. A customer care professional will ordered through Anthem Rx mail service and delivered directly to your home, obtain all necessary information and office or anywhere in the United States. guide you through the process, quickly and easily. Once your prescriptions are entered into the mail service system, you can use the Anthem Rx 24-hour automated phone line to order refills and check order Getting refills of prescriptions filled status. by Anthem Rx: 1. Have your prescription label(s) ready. 2. Call (800) 962-8192 for personal Save on copayments service or to use the 24-hour Anthem Rx mail service provides more days' supply with fewer copayments. automated phone line. 3. To use the automated phone line, You'll typically save at least one copayment on each prescription filled by the press 3. Anthem Rx mail service pharmacy. a) When asked, enter the seven-digit number from your prescription label. At Anthem Rx, your prescription orders are filled by registered pharmacists b) Enter a credit card number you have who dispense federally approved, A-rated generic equivalent medications for previously used with Anthem Rx. brand-name medications unless your physician directs otherwise. This helps c) Wait to confirm the refill, then repeat save you money while providing quality, effective drug therapy. step a) if you need additional refills. How to get answers to your Anthem Rx customer care: (800) 962-8192 prescription benefit questions: 1. Have your policy ID number ready. For additional information about your prescription benefits, you may call an 2. Call (800) 962-8192 and press 2 for Anthem Rx customer care professional at (800) 962-8192 Monday through order status. Friday, 9 a.m. to 11 p.m., or on Saturday from 9 a.m. to 5 p.m. Eastern time. 3. You can press 0 to talk directly to a customer care professional. Please allow 10 business days to receive all mail service order P-569 (8/99) Independent Licensees of the Blue Cross and Blue Shield Association. Registered marks Blue Cross and Blue Shield Association. Anthem Rx Prescription Order Form Customer Service Anthem Prescription Management, Inc. (800) 962-8192 P.O. Box 746000 Mon.- Fri. 9 am - 11 pm EST Cincinnati, Ohio 45274-6000 Fold in thirds and mail in envelope Sat. 9am - 5 pm EST For refills, it is only necessary to fill out the top portion of this form. Ship to: Policy holder's name Policy holder ID # Phone # (day) Phone # (evening) Street City State Zip code Payment information (make check or money order payable to Anthem Rx or apply to your credit card) VISA MasterCard Discover Credit card # Exp. Date Mon. Yr. Total amount due $ Please sign for credit card order Do you want childproof caps used? Yes No Please use the order form for all orders: Refill Prescription Orders Refill number Patient name Medication names Refill numbers Patient name Medication names Anthem Rx pharmacist will dispense federally approved, cost-saving generic equivalent drugs for brand-name drugs unless your physician directs otherwise. TO REORDER TO REORDER PLACE REFILL LABEL HERE PLACE REFILL LABEL HERE TO REORDER TO REORDER PLACE REFILL LABEL HERE PLACE REFILL LABEL HERE New prescription orders (complete this form when enclosing new prescriptions -- one entry per patient). Name of patient for whom the prescription is enclosed Date of birth Sex Relationship Male Self Have you taken this medication before? Yes No Female Spouse Child Doctor(s) name(s) Doctor(s) phone numbers(s) Drug allergies/health conditions Doctor(s) name(s) Doctor(s) phone numbers(s) Drug allergies/health conditions Name of patient for whom the prescription is enclosed Date of birth Sex Relationship Male Self Have you taken this medication before? Yes No Female Spouse Child Doctor(s) name(s) Doctor(s) phone numbers(s) Drug allergies/health conditions Doctor(s) name(s) Doctor(s) phone numbers(s) Drug allergies/health conditions Having difficulty filling out this form? Call our special Anthem Rx Helpline, (888) 613-6091, to have a customer care professional guide you through the process.