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1-877-231-8302 FAX NUMBER 1-877-732-3431 1-888-347-3416 PHONE NUMBER ... Optum Specialty Pharmacy 1-877-445-6874 1-877-342-4596 *This table is current as of 08/01 ... 1-877-342-4596 Call 1-877-445-6874 Ready to prescribe? Just e-prescribe, fax or call in your patient’s prescription to Optum® Specialty Pharmacy. We’ll handle the rest. Once we receive the prescription, we will: • Complete a benefits investigation and prior authorization • Aid patients in obtaining financial assistance programs

At Optum® Specialty Pharmacy, we offer resources, programs and clinical support to help manage your diagnosis with confidence. Optum Specialty Phone: 877-445-6874 | Optum Specialty Fax: 877-342-4596 . Specialty Pharmacy Enrollment Form . This form is not a valid prescription in Arizona . Please detach before submitting to a pharmacy – tear here . PATIENT INFORMATION PRESCRIBER INFORMATION . Please complete the following or send patient demographic sheet . …Optum Specialty Pharmacy 877-445-6874 877-342-4596 Accredo Health Group 877-732-3431 877-783-2262 866-352-3973 CVS Specialty 888-280-1193 855-296-0210 Check with your patient’s insurance for specific coverage requirements and … Oncology Oncology Phone: 877-445-6874 Enrollment Form Oncology Enrollment FormOncology Phone: 8774456874 Fax: 8773424596 Specialty Pharmacy Enrollment Formulas detach before submitting to a pharmacy tear here.

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