| 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 |
Due to a planned data migration beginning Friday, January 10 at 11:00 p.m., and continuing through Monday, January 13 at 8:00 a.m., you may experience a delay in your information appearing on CareFirst portals. We expect that changes to member data will be reflected on the portals by Wednesday, January 15. Your patience is appreciated.
Change Healthcare notifying individuals of data breach. Learn more here.
Prescription Drug Forms
Drug
Prior Authorization