Prescription Claim Reimbursement

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:

1. 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.
2. Group/Employer Name or Number
3. Policy Number
4. Patient Name
5. Reason that prescription card was not used at the time of service.