Medicare Prescription Drug Plan Information & Forms | UnitedHealthcare®
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Prescription Drug Plans

Medicare Prescription Drug Plan Information and Forms

Find helpful 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.

My account

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.

Mail-order forms

Enrollment forms

To get an enrollment form for an AARP MedicareRx plan, go to View plans and pricing and enter your ZIP code. Choose one of the available plans in your area and view plan details. You’ll find the form you need in the Helpful Resources section.

Payment and reimbursement forms

Authorization forms

Pharmacy Directory

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)

Other forms and plan materials

To request disenrollment from your Medicare prescription drug plan and switch to Original Medicare only, you have two options to choose from:

Page last updated: 04.27.2017 at 12:01 AM CT | Y0066_170315_164551 Accepted

Find Medicare Prescription Drug Plans in Your Area

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