Simply complete the Express Scripts prescription claim form and mail it to the address listed on the form. To ensure completion of the claim, tape receipts and important claim information to the form, including:
- Date prescription filled
- Name and address of pharmacy
- Doctor name or ID number
- NDC number (drug number)
- Name of drug and strength
- Quantity and days’ supply
- Prescription number (Rx number)
- DAW (Dispense as Written)
- Amount paid
If you have questions, contact Express Scripts directly at 1-800-497-4641 (with an AT&T USADirect® access code if you are traveling).