For Members with Employer-Sponsored Coverage

OMNICARE EMPLOYEES
	For all enrollment and benefits questions including: Co-pays Inclusions/Exclusions Prior Authorizations Direct Member Reimbursements Contact CLARITY at 1-800-350-6714
	Submit a new prescription or refill request to the PBM Plus Mail Order Pharmacy
	Mail Service Refill / New Order (printable) Mail Service Refill / New Order (online)
	Privacy Statement
	Mail Service Acknowledgement of Receipt of Privacy Statement (printable)
	Apply for Direct Member Reimbursement (not for Omnicare Employees)
	Direct Member Reimbursement (printable)
	Request a replacement ID card (not for Omnicare Employees)
	ID Card Replacement (online)
For Individuals NOT Covered by an Employer-Sponsored Pharmacy Plan
	Enroll for independent prescription coverage through the PBM Plus Mail Service discount prescription plan
	Mail Service Discount Plan Enrollment (printable) Mail Service Discount Plan Enrollment (online)
	Privacy Statement
	Mail Service Acknowledgement of Receipt of Privacy Statement (printable)
For Clients
	Form for Benefit Change
	Benefit Change (Printable)
For Pharmacists
	Form to Request a Prior Authorization
	Prior Authorization Request (printable)
	Payer Sheet
	5.1 Payer Sheet (printable)
	Pharmacy Network Agreement
	Pharmacy Network Agreement (printable)
For Physicians
	Form to Request a Prior Authorization
	Prior Authorization Request (printable)