Send us your prescription inventory to help determine if an adjustment needs to be made to your coverage. Download the PDF form to your computer, open it up and fill out the fields provided, save it, and upload it below. For your privacy, the form will be encrypted for security. You can also print it, fill it out by hand, and fax it to us at 630-477-0775.
To download the form, click on the three dots at the right and choose "download".
Your Prescription Inventory