Prescription Drug Forms

Drug

Brand Exception Request Form
Maintenance Medication Request Form
Non-Formulary Drug Exception Form
Tier Exception Form
Prescription Reimbursement Claim Form
Mail Service Pharmacy Order Form
MedWatch Form - To report a serious or adverse event, product quality or safety problem, etc. to the FDA
Virginia Members Only - Transition Fill Form
Maryland Members Only - Transition Fill Form
DC Members Only - Transition Fill Form

Prior Authorization Documents & Policies

To access all Prior Authorization Fax Forms and policies for medical and pharmacy benefits, please visit the CVS Caremark* Prior Authorization Documents page.

Please note that you will be leaving the CareFirst site when you click the blue button below. You will be routed to a website owned by CVS Caremark and subject to CVS Caremark’s Privacy Policy and Terms and Conditions.

CVS Prior Authorization Documents

*CVS Caremark is an independent company that provides pharmacy benefit management services.