Can't upload documents? No problem! You can also submit your claim in the following ways:
Use the Co-pay Assistance Request Form if your prescription was filled at your pharmacy.
Use the Medical Benefit Co-pay Assistance Request Form if your prescription was filled at your prescriber's office.
Use this Co-pay assistance form if your card references KIS
Use this Co-pay assistance form if your card references SCE
Please feel free to contact us with any questions or issues regarding your account.