RX Forms
After AccuServ Receives the Completed Referral Form, We Will:
- Contact the Physician’s office within 2 hours to let them know if the prescription is accepted by AccuServ Pharmacy®.
- Check on insurance coverage for the patient and verify their copays
- Provide timely completion of prior authorizations and work with drug manufacturers and non-profit organizations to find your patients the lowest possible copays.
- Physician offices and patients are notified of the status of the prescription throughout the Prior Authorization and Financial assistance process.
- After AccuServ receives approval of the prescription, we will contact the patient to set up delivery and answer any questions they may have.
- Once the patient receives their medication, an AccuServ team member will review their medication with them, and provide helpful resources on side effects and how to manage their condition.
- AccuServ will continue to work with the patient during therapy to help maintain adherence. From our specialized packaging, to refill reminders, we do our best to make sure managing medications is simple.
High Patient Adherence
At AccuServ we help make it easier for patients to take the right medication at the right time, every time. Our AccuPac® packaging allows our patients and family caregivers a simple way to manage even complex medication regimens with confidence.
Available Forms
- AccuPac Form
- Crohn’s Referral Form
- Cystic Fibrosis
- Dermatology Referral Form
- Dermatology Additional Referral Form
- Heart Transplant Referral Form
- Hepatitis B Referral Form
- Hepatitis C Referral Form
- HIV Referral Form
- Hypercholesterolemia Referral Form
- Mental Health Referral Form
- Multiple Sclerosis Referral Form
- Oncology Referral Form
- Osteoarthritis Referral Form
- Osteoporosis Referral Form
- Rheumatology Referral Form
- Rheumatology Additional Form
- Transplant Referral Form
- Urology Referral Form
- Vivitrol Referral Form
Financial Assistance
AccuServ employees are experts at obtaining maximum coverage for our patients and working through challenging reimbursement issues. We manage your Prior authorizations and work with drug manufacturers and non-profit organizations to obtain the lowest copays possible.