Helping you manage pharmacy benefits Forms and Formularies

Universal (Open) Formulary

A universal or open formulary is a list of prescription drugs used by practitioners to identify medications that offer the greatest overall value. It represents an abbreviated version of the drug list (formulary) that is at the core of your prescription drug benefit plan. The list is not all inclusive and does not guarantee coverage. In addition to using this list, you are encouraged to ask your doctor to prescribe generic drugs whenever appropriate.

Benefit designs may vary with respect to drug coverage, cost, quantity limits, step therapy, days supply and prior authorization. Changes may occur throughout the year and plan exclusions may override this list. For more information, please contact a True Rx Customer Service Representative at 866.921.4047.

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Exclusive (Narrow) Formulary

An exclusive or narrow drug formulary is a list of prescription drugs used by practitioners to identify medications that offer the greatest overall value. It represents an abbreviated version of the drug list (formulary) that is at the core of your prescription drug benefit plan. The list is not all inclusive and does not guarantee coverage. In addition to using this list, you are encouraged to ask your doctor to prescribe generic drugs whenever appropriate.

Benefit designs may vary with respect to drug coverage, cost, quantity limits, step therapy, days supply and prior authorization. Changes may occur throughout the year and plan exclusions may override this list. For more information, please contact a True Rx Customer Service Representative at 866.921.4047.

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Prior Authorization Form

A Prior Authorization is the process in which information regarding a certain medication is gathered and clinically evaluated to determine if the prescription benefit plan will cover their portion of the medication cost. Some plans set limits on certain medications due to age, efficacy, cost, and availability.

If a prior authorization is needed, your doctor's office will need to complete this form. Instructions, including contact information, are included on the form.

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Mail Order Form

If your plan allows, you may have access to home delivery for medications. This is provided by Postal Prescription Services. For more information, you may visit their website or download the mail order form.

If have questions, please call postal prescription services at 800-552-6694.

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Reimbursement Form

Rare circumstances may occur when you may be due a refund from True Rx Health Specialists for a medication that was not covered initially at the pharmacy. If this is the case, simply download the drug reimbursement claim form and follow the instructions. Mailing instructions are included at the bottom of the page.

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