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At-Home COVID-19 Test Options
Member FAQs
EpiphanyRx Member FAQs
Over-the-Counter (OTC) COVID-19 Tests FAQs
Formulary and Drug Lists
EpiphanyRx Formulary
EpiphanyRx ACA Preventive Drug List
EpiphanyRx HSA Preventive Drug List
EpiphanyRx Maintenance Drug List
Home Delivery Information
Home Delivery Flyer
Costco Patient Profile Form
Visit Costco Pharmacy
Reimbursement Claim Forms
EpiphanyRx Member Reimbursement Form
EpiphanyRx Compound Claim Reimbursement Form
EpiphanyRx COVID-19 Test Claim Form
Other Forms
Release of Information Form
Providers
Prior Authorization Form
Payer Sheet - Link to the Navitus, our parent company, pharmacy portal
Pharmacy Network Application and Credentialing Form
Pharmacy Manual
MAC Appeal Form - Link to the Navitus, our parent company, pharmacy portal
Exception to Coverage Request
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