Part D Claim form
2023
For Medicare Part D drug claims, please complete this form and mail with receipts to:Express Scripts
ATTN: Medicare Part D
PO Box 14718
Lexington, KY 40512-4718
Or
Fax completed form with receipts to: 1-608-741-5483
2024
For Medicare Part D drug claims, please complete this form and mail with receipts to:
Navitus Health Solutions Manual Claims
PO Box 1039
Appleton, WI 54912-1039
Or
Fax completed form with receipts to: 1-855-668-8550