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Related Topics First Fill Forms

 

 

 

  • Pharmacy Expenses

Before seeking medical treatment you should complete and print a first fill form. The first fill form can be accessed by selecting the first fill tab from the menu at the top of this page or to the left of this page under "related topics." This form shold be presented along with your prescription to the network pharmacy of your choice. A network pharmacy can be found HERE. The network includes: CVS, Kroger, Publix, Rite-Aid, Target, WalMart and Walgreens as well as most independent pharmacies.

The first fill form can be used on a one-time basis at a network pharmacy of your choice with no out-of-pocket expense. The first fill form entitles you to a 10-day supply of medication. Upon acceptance of the claim, Cypress Care will mail a pharmacy card which is to be presented each time you fill a prescription.

For most injuries use of the first fill form allows for a 10-day supply of medicine with a limit of $150 per prescription.

For injuries involving blood borne exposures you are allowed a 14-day supply of a prophylactic medicine with a limit of $1,000 per prescription.

Complete and print the first fill form. Present it to the network pharmacy of your choice along with your prescription. The first fill form can be accessed by selecting the first fill form tab from the menu at the top of this page or to the left of this page under "related topics."

 

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