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Resources

Members

Member FAQs

EpiphanyRx Member 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

Other Forms

Release of Information Form

Providers

Prior Authorization Form

Payer Sheet - Link to the Navitus, our parent company, pharmacy portal

Navitus Pharmacy Network Credentialing Form

Navitus Pharmacy Manual

MAC Appeal Form - Link to the Navitus, our parent company, pharmacy portal

Exception to Coverage Request

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