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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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