Instructions for completing the drug claim form
Use the Prescription Reimbursement Claim Form to request reimbursement for a prescription drug purchase when:
- You have paid in full for the drug and HMSA is either your sole drug plan or your primary drug plan, or
- HMSA is your secondary drug plan carrier and you have already received a statement of payment from your primary drug plan carrier.
You must complete a separate claim form for each pharmacy and for each patient.
Submitting the claim form
- To consider reimbursement, CVS Caremark must receive your claim within one year of the date of purchase of the drug(s).
- Keep a copy of the form and receipt(s) for your records.
- Send the completed form to CVS Caremark at the address listed on the second page of the claim form.
Questions about your claim or your HMSA prescription drug coverage
- If you need assistance in completing the claim form, would like to check the status of a claim you already submitted, or have questions about your HMSA drug coverage, please call HMSA Customer Relations and select the Drug option to speak with a CVS customer care representative.
- Representatives are available to serve you 24 hours a day, seven days a week.