Referral Forms

Once we receive the completed referral form AccuServ’s staff will:

  • Contact the Physician’s office within 2 hours to let them know if the prescription is accepted by AccuServ Pharmacy.
  • Verify insurance coverage (including co-pays) and file the claim with the insurance carrier.
  • Provide prior authorization (PA) and financial assistance (FA) support to ensure patient receives the lowest possible copays.
  • Physician offices and patients are notified of the status of the prescription throughout the Prior Authorization and Financial assistance process.
  • AccuServ will contact the patient to coordinate delivery of the medication and to review their support services once the prescription is approved.
    • After the medication is received, AccuServ pharmacy will discuss with the patient their medication(s), anticipated side effects and how to contact the pharmacy with any questions.
    • AccuServ’s specialty care coordinators will partner with the patient throughout the course of therapy to maintain adherence, monitor and report side effects, and ensure patient access to available resources