Express Scripts Home Delivery Order Form Instructions
This file contains detailed instructions on how to order prescriptions through Express Scripts Home Delivery. It includes various methods of placing an order, payment options, shipping methods, and other important information. Suitable for members requiring easy access to their medications.
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How do I fill this out?
To fill out this form, you will need your prescription information, personal details, and payment method. Follow the steps provided carefully to ensure accurate submission. Detailed instructions for each section are provided below.
How to fill out the Express Scripts Home Delivery Order Form Instructions?
1
Begin with member information by filling in your Member ID and personal details.
2
Provide the correct shipping address where you want your medications to be delivered.
3
Fill in the patient information for each person covered under this order.
4
Choose your preferred payment method and sign to authorize the payment.
5
Review the information, then send the completed form along with your prescriptions.
Who needs the Express Scripts Home Delivery Order Form Instructions?
1
Members who want to switch to home delivery for their medications.
2
Individuals needing a 90-day supply of their prescription medication.
3
Patients preferring the convenience of having medications delivered to their home.
4
Doctors submitting electronic or faxed prescriptions on behalf of their patients.
5
Patients seeking automated payment options for easier management of their orders.
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1
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2
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Use the tools available to add, delete, or modify text as needed.
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Review the changes to ensure accuracy and completeness.
5
Save and download the updated PDF.
What are the instructions for submitting this form?
To submit the form, you can: ePrescribe: Ask your doctor to electronically send your prescription to Express Scripts PharmacySM. Online: Log in to express-scripts.com or the Express Scripts Mobile App, add your selected medicines to your cart, and check out. Fax: Have your doctor call 888.327.9791 for instructions. Phone: Call Express Scripts at the toll-free number on the back of your ID card for assistance. Mail: Send the completed form, prescriptions, and payment to: EXPRESS SCRIPTS, PO BOX 66577, ST LOUIS, MO 63166-6577.
What are the important dates for this form in 2024 and 2025?
NA
What is the purpose of this form?
The purpose of the Express Scripts Home Delivery Order Form is to streamline the process of ordering and receiving prescription medications for members. By using this form, members can conveniently switch to home delivery, ensuring a steady supply of their essential medications without the need for frequent pharmacy visits. This form accommodates various order methods, payment options, and shipping preferences to cater to the diverse needs of Express Scripts members.
Tell me about this form and its components and fields line-by-line.
- 1. Member Information: Includes Member ID, last name, first name, and email address.
- 2. Shipping Address: Details the address where medications will be shipped, including temporary addresses if applicable.
- 3. Patient Information: Contains patient names, dates of birth, genders, and physician details.
- 4. Payment Method: Offers different payment methods including credit card and checking account information.
- 5. Health History: Updates on allergies or health conditions for safety.
- 6. Important Reminders: Includes Medicare Part B information and medication return policy.
- 7. Generic Substitution: States preferences for generic or brand-name medications.
What happens if I fail to submit this form?
Failing to submit this form may result in delays or inability to receive your prescription medications.
- Medication Unavailability: Without submission, the medications cannot be processed and delivered.
- Interrupted Treatments: Failure can lead to interruptions in ongoing medication treatments.
- Increased Costs: Missing submission deadlines may result in higher costs for expedited shipping or urgent refills.
How do I know when to use this form?
- 1. Switch to Home Delivery: Use the form to switch from pharmacy pick-up to home delivery.
- 2. Order for Multiple Patients: Include information for multiple patients under one member ID.
- 3. Update Payment Method: Use the form to update or change your payment method for prescription orders.
Frequently Asked Questions
How can I edit the Express Scripts Order Form?
You can edit the form using PrintFriendly's PDF editor by uploading the file and making necessary changes directly in the document.
Can I sign the Express Scripts Order Form on PrintFriendly?
Yes, PrintFriendly allows you to digitally sign the form, ensuring that your submission is authenticated and valid.
What are the different ways to submit the Express Scripts Order Form?
You can submit the form via mail, fax, phone, online, or through the mobile app, as detailed in the instructions.
How do I fill out the payment section of the form?
Enter your credit card or checking account information, choose your preferred payment method, and sign to authorize the payment.
What information do I need to provide in the shipping address section?
Include your complete address, primary and secondary phone numbers, and choose the shipping method that suits your needs.
Can I add multiple patients to one order form?
Yes, you can include information for multiple patients covered under the same Member ID.
What should I do if I make a mistake on the form?
Use PrintFriendly's editing tools to correct any errors before submitting the form. Ensure all information is accurate.
How do I track the status of my order?
You can track the status of your order by logging into express-scripts.com or using the Express Scripts Mobile App.
What should I do if I need help filling out the form?
Contact Express Scripts Member Services at the toll-free number on your ID card for assistance with the form.
Is it safe to provide my payment information on the form?
Yes, all personally identifiable information collected is protected and kept secure for your convenience.
