For Members with Employer-Sponsored Coverage

OMNICARE EMPLOYEES
	Click here for Omnicare Employee Benefit Information
	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
	Direct Member Reimbursement (printable)
	Request a replacement ID card
	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)
	Payer Sheet for COB Claims
	5.1 Payer Sheet for COB Claims (printable)
	Pharmacy Network Agreement
	Pharmacy Network Agreement (printable)
	W-9
	W-9 Form (printable)
For Physicians
	Form to Request a Prior Authorization
	Prior Authorization Request (printable)