Fax: 1-877-378-4727-2025

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The document is a Prior Approval Request form for the prescription drug SPINRAZA, intended for patients diagnosed with Spinal Muscular Atrophy (SMA). It requires completion by both the cardholder and the prescribing physician, detailing patient information, diagnosis confirmation, treatment history, and necessary medical tests. The form must be submitted to the Service Benefit Plan for processing, with instructions provided for electronic submission, phone inquiries, and faxing. Incomplete forms will be returned.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the fax number for Ascension mail order pharmacy?

Ask your clinician to fax a prescription to 1-833-347-0798 or. Call us at 1-833-Meds-ARx (1-833-633-7279 and we can coordinate with your doctor)

What is the fax number for Amazon pharmacy?

Our E-Scribe name is Amazon.com Amazon Pharmacy Home Delivery. Our fax number is 512-884-5981. Our address is 4500 S Pleasant Valley Rd, Suite 201 Austin, TX 78744.

What is the fax number for FEP Medicare Prescription Drug Program?

Mail the completed disenrollment form to FEP Medicare Prescription Drug Program, PO Box 3539, Scranton, PA 18505 or fax to 855-865-1817.

What is the fax number for express script prior authorization?

After the form has been completed, it can be faxed to Express Scripts at 1-877-251-5896 for review. Express Scripts will notify your doctor of the approval or denial within 48 hours of receipt of the prior authorization form. Electronic Prior Authorization. Visit for more information.

What is the fax number for FEP pharmacy?

Use the form that matches your benefits program (FEHB or PSHB) to disenroll from MPDP. Mail the completed form to FEP Medicare Prescription Drug Program, PO Box 3539, Scranton, PA 18505 or fax to 855-865-1817.