Optumrx mail order 2026

1. Click ‘Get Form’ to open the optumrx mail order form in the editor.
2. Begin by entering your Primary Member ID Number and, if applicable, your Secondary Member ID Number. Fill in your personal details including First Name, Last Name, MI, Delivery Address, City, State, ZIP Code, Date of Birth, and Gender.
3. Provide your Physician's Name and their Phone Number. Indicate any medication allergies by checking the relevant boxes and list any health conditions you may have.
4. In the Pharmacy processing section, specify if you prefer generic substitutions or brand-name medications. If you want to keep prescriptions on file for future shipments, list them here.
5. Complete the Payment and shipping information section. Choose your payment method and provide necessary details like credit card information if applicable. Remember to sign and date the form before submission.

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