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Retiree Medical, Prescription Drug and Mental Health and Substance Abuse Programs - RR Donnelley   
How to File a Claim
Filling Prescriptions at Non-Participating Retail Pharmacies
CVS Caremark is the claims administrator and network manager for the Prescription Drug Program.
You or your spouse is responsible for paying the full cost at the time you or your spouse has your prescription filled. You or your spouse must complete a Prescription Drug Claim Form, which is available by calling the claims administrator at the phone number listed on your prescription ID card.
Complete the form (you or your spouse may want to keep a copy for your records) and send it, with the original receipts attached, to the claims administrator at the address on the form. It is important that you or your spouse fill out the claim form completely, including:
 | The name of the drug received (when filing a claim for prescriptions outside the United States);
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| The name of the pharmacy dispensing the drug, and the seven-digit NCPDP (National Council for Prescription Drug Programs) number of the pharmacy;
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| The date you or your spouse purchased the drug;
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| The prescription number, name, NDC# (National Drug Code number) supply (number of days), and quantity of the drug; and
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| Your signature. |
You or your spouse must also include an itemized receipt that shows the amount you or your spouse paid for each prescription. When your claim is processed and approved, you or your spouse may receive a partial reimbursement of the retail cost depending on the Medical Program you choose.
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