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Pharmacy Forms
Pharmacy Forms

Consent to Arrange for Payment and Release Information Form
Explanation of Consent Form
Prescription Drug Reimbursement Form
Prior Authorization / Exception Form
Growth Hormone Statement of Medical Necessity Form
Short Term Health Plan - Prescription Claim Review Form

Mail Order Forms
Mail Order Pharmacy Order Form
Over-the-counter Mail Order Form

Do you have two health plans that cover your pharmacy claims?

If HealthPartners is the secondary plan, your pharmacy can now bill your secondary claims online. Simply show your pharmacy the membership card of your primary health plan along with your HealthPartners Member ID card. The pharmacy will do the rest! This will eliminate you needing to file a paper claim to be reimbursed for your copayment.

If your plan does not support coordination of benefits, your secondary claim may also require a copayment.