| 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 |
ATTENTION: CareFirst will file Federal RxDC reports for 2024 by June 1, 2025. All current clients with medical or pharmacy products through CareFirst in 2024 must complete the Annual RxDC Information Submission form under Quick Links by May 12, 2025, to be included in CareFirst's D1-Premium & Life Years data filing.
Change Healthcare notifying individuals of data breach. Learn more here.
Prescription Drug Forms
Drug
Prior Authorization