Express scripts fax form 2026

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  1. Click ‘Get Form’ to open the express scripts fax form in the editor.
  2. Begin by filling out the 'Patient' section. Ensure you include your Member ID, First Name, Last Name, Address, Date of Birth, and Phone number.
  3. Next, complete the 'Doctor/Prescriber' section. Fill in the Doctor's name, DEA number, Address, Phone number, and Fax number.
  4. In the 'Patient Options' section, select any preferences such as non-child resistant caps or rush delivery if needed.
  5. For prescriptions, provide details in the Rx section including Drug Name/Form/Strength and Quantity. Ensure your doctor signs where indicated.
  6. Finally, review all entries for accuracy before submitting your completed form via fax or mail as per instructions provided.

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Your provider can also fax your prescription to Express Scripts Pharmacy they can call (888) 327-9791 for faxing instructions. Be sure to give them your member ID number. (Only providers can fax prescriptions.)
You should ideally select a known pharmacy to fax a prescription. You shouldnt fax a prescription directly to a pharmacy by yourself. Instead, ask your healthcare professional or a qualified medical staff to do it. Ensure the faxed prescription has all the necessary information, including the prescribers signature.
Electronically: For fastest service, they can send your prescription electronically to Express Scripts Home Delivery, NCPDP 2623735. 2. By fax: They can call 888.327. 9791 to get a Fax Order Form.
Call your doctors office. Ask them to send your prescription electronically to Express Scripts for up to a 90-day supply of your medication. Call 877.363. 1303.
Your doctor can fax this form to Express Scripts at: 877-895-1900. 602-586-3911 (overseas)

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