Plan Information and Forms
Find helpful prescription drug plan resources including forms, plan materials and more.
Note: PDF (Portable Document Format) files can be viewed with Adobe® Reader®. If you don't already have this viewer on your computer, download it free from the Adobe website - Opens in a new window.
Sign in to view details about your coverage. When you sign in, you can track and manage your spending to date, including your total drug costs and out-of-pocket costs. You can also print a temporary member ID card or order a replacement member ID card, among other tasks. If you don't have an account, please register.
Prescription drug mail order forms
Premium payment information
Medication authorization forms
Some medications require information from the prescriber (for example, your primary care physician) before filling the prescription. The prior authorization form can be given to your prescriber to complete and return to OptumRx for processing.
Use the online directory to find a pharmacy and map its location.
For more information about network pharmacies, please take a look at the Pharmacy Directory Information (PDFs) below.
AARP MedicareRx Walgreens plan (PDP)
AARP MedicareRx Preferred plan (PDP)
AARP MedicareRx Saver Plus plan (PDP)
Symphonix Value Rx plan (PDP)
To get an enrollment form for a UnitedHealthcare Medicare Part D plan, go to View plans and pricing and enter your ZIP code. Choose one of the available plans in your area and view the plan details. You'll find the form you need in the Plan Documents section.
To request disenrollment from your Medicare prescription drug plan and switch to Original Medicare only, you have two options to choose from: