Medication Benefit Management Redefined
Change Begins with Sav-Rx. Full service Pharmacy Benefit Manager focused on lowest net cost, highest customer satisfaction and full flexibility for our clients and their patients.
Change Begins with Sav-Rx. Full service Pharmacy Benefit Manager focused on lowest net cost, highest customer satisfaction and full flexibility for our clients and their patients.
OTC COVID-19 Test Order Page
OTC COVID-19 Test Order FormSav-Rx Group Number:
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Card Information | |
Sav-Rx Group Number: | |
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Sav-Rx Card Number: | |
Cardholder First Name: | |
Cardholder Last Name: | |
Patient Information | |
Patient First Name: | |
Patient Last Name: | |
Patient Date Of Birth: | |
Patient Relationship: | |
Delivery Information | |
Delivery Address: | |
Address (cont): | |
City: | |
State: | |
Zip: | |
Phone: | |
Phone Type: | |
Email: | |
Required
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*This form will allow you to order eight (8) OTC COVID-19 tests per individual per calendar month. If you have already utilized your prescription benefit to purchase one or more OTC COVID-19 tests at a retail pharmacy this month, then you will need to wait until the next calendar month to order eight (8) tests. Your health plan covers at 100% a maximum of eight (8) OTC COVID-19 tests per individual per calendar month.
**Due to global supply chain issues, in stock is not guaranteed.