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Specialty Pharmacy Enrollment Forms
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For use within the US
For additional enrollment forms, please contact Sales Support at pghsalessupport@caremark.com.
Condition
MS Word Version
Adobe PDF Version
Acromegaly
MS Word
Adobe PDF
Actiq
MS Word
AdobePDF
Alcohol Dependence
MS Word
Adobe PDF
Aranesp
MS Word
AdobePDF
Allergic Asthma
MS Word
Adobe PDF
CAPS Syndrome
MS Word
Adobe PDF
Cystic Fibrosis
MS Word
Adobe PDF
Crohn's Disease
MS Word
Adobe PDF
Dermatology/Psoriasis
MS Word
Adobe PDF
Fertility (Mid West)
MS Word
Adobe PDF
Fertility (National)
MS Word
Adobe PDF
Forteo
MS Word
Adobe PDF
Gastroenterology
MS Word
Adobe PDF
General (Blank) Caremark Specialty Enrollment Form
MS Word
Adobe PDF
Growth Hormone Disorders
MS Word
Adobe PDF
Hematopoietics
MS Word
Adobe PDF
Hemophilia (& Related Bleeding Disorders)
MS Word
Adobe PDF
Hepatitis C
MS Word
Adobe PDF
Hepatitis C Stat Medications
MS Word
Adobe PDF
Hereditary Angioedema
MS Word
Adobe PDF
HIV
MS Word
AdobePDF
HIV/Co-Infection
MS Word
AdobePDF
Immune Disorders (General and IVIG)
MS Word
Adobe PDF
Lucentis
MS Word
AdobePDF
Lupus
MS Word
AdobePDF
Lysosomal Storage Disorders
MS Word
Adobe PDF
Macugen
MS Word
Adobe PDF
Macular Degeneration
MS Word
Adobe PDF
Mirena
Adobe PDF
Multiple Sclerosis
MS Word
Adobe PDF
Oncology Orals Hematologic Malignancies
MS Word
Adobe PDF
Oncology Orals Solid Tumors
MS Word
Adobe PDF
Osteoarthritis
MS Word
Adobe PDF
Osteoporosis
MS Word
Adobe PDF
Procrit
MS Word
Adobe PDF
Pulmonary Arterial Hypertension
MS Word
Adobe PDF
Respiratory Syncytial Virus (RSV)
MS Word
Adobe PDF
Rheumatoid Arthritis
MS Word
Adobe PDF
Rheumatology
MS Word
Adobe PDF
Rheumatology IV
MS Word
Adobe PDF
Rheumatology Subcutaneous
MS Word
Adobe PDF
Soliris
MS Word
Adobe PDF
Transplant
MS Word
Adobe PDF
How May We Help You?
Let CVS Caremark Specialty Pharmacy get your patients started on treatment today.
Call CaremarkConnect
Phone: 1-800-237-2767
Fax: 1-800-323-2445
Now Available
Treating SLE: Benlysta® (Human Genome Sciences/ GlaxoSmithKline), was approved by the U.S. Food and Drug Administration (FDA) on March 10, 2011, for the treatment of active, autoantibody-positive systemic lupus erythematosus (SLE). SLE or "lupus" is a chronic autoimmune disease in which the body's own immune system attacks and destroys healthy tissue.
Please contact your CareTeam for more information.
Pharmacy Drug List
CVS Caremark Specialty Pharmacy Drug List
We provide one of the broadest offerings of specialty pharmaceuticals in the industry
