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Mail order prescription physician fax form. Before you send us a prescription and to minimize any delays or outreach…. Use this form to order a new mail service prescription by fax from the prescribing physician’s office.
Use this form to order a new mail service prescription by fax from the prescribing physician’s office. Member completes section 1, while the physician completes sections 2 and 3. This fax is void unless received directly from physician’s office. To contact Optum Rx, physicians may call 1-800-791-7658.
Optum® Home Delivery Pharmacy is a full service mail order pharmacy with the convenience of delivering medications directly to your home. Benefits include free standard shipping, 24/7 pharmacist access and more.
Complete prescription information. 90 day supply is preferred. Customer service phone number: 1-800-562-6223 Physician’s line: 1-800-791-7658. Note: Schedule II medications cannot be faxed. This is not a valid prescription in Arizona. Sign and fax back to: 1-800-491-7997. [alt fax: 1-760-476-0406]
Mail this completed order form with your new prescription(s) to OptumRx, P.O. Box 2975, Mission, KS 66201. DO NOT STAPLE OR TAPE PRESCRIPTIONS TO THE ORDER FORM.
Mail this completed order form with your new prescription(s) to Optum Rx, P.O. Box 2975, Mission, KS 66201. Do not staple or tape prescriptions to the order form.
Fax 1-800-491-7997 – Send a complete prescription using the Physician Fax Form. Please do the following prior to submitting the prescription for your patient: Verify with your patient if they wish to use Optum® Home Delivery as their pharmacy.
