FlexScripts members, wishing to be reimbursed, or have applied to their deductibles, prescriptions that were paid out of pocket should submit the following information for manual reimbursement of claims:
- The original pharmacy receipt (not a cash register receipt) or a printout that includes the Prescription Number(s), Date(s) of Service, Drug Name(s), NDC Number(s), Quantities, Days Supply, and Amount(s) Paid.
- Group/Employer Name or Number
- Policy Number
- Patient Name
- Reason that prescription card was not used at the time of service.
If this is a request for a coordination of benefits (COB) with another insurance carrier, please be sure to submit the corresponding explanations of benefits (EOB) along with the pharmacy information.
Mail the requested information to:
1205 South 70th street
West Allis, WI 53214
Or fax it to: 414-302-9837