Download Enrollment Forms
Send your patient’s specialty Rx and enrollment form to us electronically, by phone or fax.
At CVS Specialty®, our goal is to streamline onboarding and help get patients the medication they need as quickly as possible. We offer access to specialty medications and infusion therapies, centralized intake and benefits verification, and prior authorization support.
For health care providers, select your patient’s specialty condition or therapy listed below. Then, download and complete the appropriate enrollment form. Providers can ePrescribe, phone, or fax their patients’ prescriptions to CVS Specialty. Use the contact information on the enrollment form to help ensure timely prescription processing.
Select the starting letter of the specialty therapy/condition or medication.
A
|
Acromegaly |
|---|
|
Alpha1 Proteinase Inhibitor Deficiency |
|
Amyloidosis |
|
Apretude Cabenuva |
|
Aranesp |
|
Asthma |
|
Atopic Dermatitis |
|
Autoimmune IV |
B
|
Betaine Anhydrous |
|---|
|
Brixadi |
C
|
Cabenuva Apretude |
|---|
|
CAPS Syndrome |
|
Cardiology |
|
COPD |
|
Cystic Fibrosis Inhaled Therapies |
|
Cystic Fibrosis Oral Therapies |
|
Cystinuria |
D
|
Dermatology Psoriasis |
|---|
|
Desferal |
|
Duchenne Muscular Dystrophy |
E
G
|
Gastroenterology |
|---|
|
General CVS Specialty Enrollment Form |
|
Gout |
|
Growth Hormone Disorders |
H
|
Hematopoietics |
|---|
|
Hemophilia |
|
Hepatitis C |
|
Hereditary Angioedema |
|
HIV |
I
|
Idiopathic Pulmonary Fibrosis |
|---|
|
Immunoglobulins (US) |
|
Inflammatory Bowel Disease |
J
K
L
|
Lupron Gynecology Women's Health |
|---|
|
Lupron Pediatric |
|
LupronDepot - Eligard-Zoladex-Firmagon |
|
Lupus |
|
Lysosomal Storage Disorders |
M
|
Migraine |
|---|
|
Movement Disorders |
|
Multiple Sclerosis Infusion |
|
Multiple Sclerosis Orals and Injectables |
|
Myasthenia Gravis Subcutaneous |
N
|
Non-Alcoholic SteatoHepatitis |
|---|
|
Nuzyra |
O
|
Oncology Breast Cancer |
|---|
|
Oncology Dermatology |
|
Oncology General |
|
Oncology Injectable and Infused |
|
Oncology Men's Health |
|
Oncology Non-Small Cell Lung Cancer |
|
Oncology Oral Medications |
|
Oncology Orals Hematologic Malignancies |
|
Oncology Orals Solid Tumors |
|
Oncology Support Therapy |
|
Osteoarthritis |
|
Osteoporosis |
P
|
PAH - Adempas |
|---|
|
PAH - Adempas REMS |
|
PAH - Infusion |
|
PAH - Opsumit |
|
PAH - Opsynvi |
|
PAH - Orals |
|
PAH - Orenitram |
|
PAH - Remodulin |
|
PAH - Remodulin Pre-Mix |
|
PAH - Tracleer PSMN |
|
PAH - Tracleer - REMS |
|
PAH - Treprostinil Injection |
|
PAH - Treprostinil Premix |
|
PAH - Tyvaso and Tyvaso DPI |
|
PAH - Uptravi PSMN |
|
PAH - Winrevair |
|
Parkinson's |
|
Pomalyst/Revlimid/Thalomid |
|
Procrit |
Q
R
|
Remicade-Remicade Biosimilars |
|---|
|
Renal |
|
Respiratory Syncytial Virus (RSV) |
|
Retinal Disorders/Ocular Specialty |
|
Rheumatology IV |
|
Rheumatology Orals Subcutaneous |
|
Ryplazim |
S
|
Sickle Cell Disease |
|---|
|
Sohonos |
|
Soliris and Ultomiris |
|
Spravato |
|
Sublocade |
|
Sunlenca |
X
Y
Select the starting letter of the specialty therapy/condition or medication.
A
|
Acromegaly (HI) |
|---|
|
Acromegaly (PR) |
|
Alpha1 Proteinase Inhibitor Deficiency (HI) |
|
Alpha1 Proteinase Inhibitor Deficiency (PR) |
|
Amyloidosis (HI) |
|
Amyloidosis (PR) |
|
Apretude Cabenuva (HI) |
|
Apretude Cabenuva (PR) |
|
Aranesp (HI) |
|
Aranesp (PR) |
|
Asthma (HI) |
|
Asthma (PR) |
|
Atopic Dermatitis (HI) |
|
Atopic Dermatitis (PR) |
|
Autoimmune IV (HI) |
|
Autoimmune IV (PR) |
B
C
|
Cabenuva Apretude (HI) |
|---|
|
Cabenuva Apretude (PR) |
|
CAPS Syndrome (HI) |
|
CAPS Syndrome (PR) |
|
Cardiology (HI) |
|
Cardiology (PR) |
|
COPD (HI) |
|
COPD (PR) |
|
Cystic Fibrosis Inhaled Therapies (HI) |
|
Cystic Fibrosis Inhaled Therapies (PR) |
|
Cystic Fibrosis Oral Therapies (HI) |
|
Cystic Fibrosis Oral Therapies (PR) |
|
Cystinuria (HI) |
|
Cystinuria (PR) |
D
|
Dermatology Psoriasis (HI) |
|---|
|
Dermatology Psoriasis (PR) |
|
Desferal (HI) |
|
Desferal (PR) |
|
Duchenne Muscular Dystrophy (HI) |
|
Duchenne Muscular Dystrophy (PR) |
E
F
|
Fertility (HI) |
|---|
|
Fertility (PR) |
|
Food Allergy (HI) |
|
Food Allergy (PR) |
G
|
Gastroenterology (HI) |
|---|
|
Gastroenterology (PR) |
|
General CVS Specialty Enrollment Form |
|
General CVS Specialty Enrollment Form (PR) |
|
Gout (HI) |
|
Gout (PR) |
|
Growth Hormone (PR) |
|
Growth Hormone Disorders (HI) |
|
Growth Hormone Disorders (PR) |
H
|
Hematopoietic: Hepatitis C (HI) |
|---|
|
Hematopoietic: Hepatitis C (PR) |
|
Hematopoietics (HI) |
|
Hematopoietics (PR) |
|
Hemophilia (HI) |
|
Hemophilia (PR) |
|
Hepatitis C (HI) |
|
Hepatitis C (PR) |
|
Hereditary Angioedema (HI) |
|
Hereditary Angioedema (PR) |
|
HIV (HI) |
|
HIV (PR) |
I
|
Idiopathic Pulmonary Fibrosis (HI) |
|---|
|
Idiopathic Pulmonary Fibrosis (PR) |
|
Immunoglobulins (HI) |
|
Immunoglobulins (PR) |
|
Inflammatory Bowel Disease (HI) |
|
Inflammatory Bowel Disease (PR) |
J
K
L
|
Lupron Gynecology Women's Health (HI) |
|---|
|
Lupron Gynecology Women's Health (PR) |
|
Lupron Pediatric (HI) |
|
Lupron Pediatric (PR) |
|
LupronDepot - Eligard-Zoladex-Firmagon (HI) |
|
LupronDepot - Eligard-Zoladex-Firmagon (PR) |
|
Lupus (HI) |
|
Lupus (PR) |
|
Lysosomal Storage Disorders (HI) |
|
Lysosomal Storage Disorders (PR) |
M
|
Migraine (HI) |
|---|
|
Migraine (PR) |
|
Movement Disorders (HI) |
|
Movement Disorders (PR) |
|
Multiple Sclerosis Infusion (HI) |
|
Multiple Sclerosis Infusion (PR) |
|
Multiple Sclerosis Orals and Injectables (HI) |
|
Multiple Sclerosis Orals and Injectables (PR) |
|
Myasthenia Gravis Subcutaneous (HI) |
|
Myasthenia Gravis Subcutaneous (PR) |
N
|
Non-Alcoholic SteatoHepatitis (HI) |
|---|
|
Non-Alcoholic SteatoHepatitis (PR) |
|
Nuzyra (HI) |
|
Nuzyra (PR) |
O
|
Oncology Breast Cancer (HI) |
|---|
|
Oncology Breast Cancer (PR) |
|
Oncology Dermatology (HI) |
|
Oncology Dermatology (PR) |
|
Oncology General (HI) |
|
Oncology General (PR) |
|
Oncology Injectable and Infused (HI) |
|
Oncology Injectable and Infused (PR) |
|
Oncology Men's Health (HI) |
|
Oncology Men's Health (PR) |
|
Oncology Non-Small Cell Lung Cancer (HI) |
|
Oncology Non-Small Cell Lung Cancer (PR) |
|
Oncology Oral Medications (HI) |
|
Oncology Oral Medications (PR) |
|
Oncology Orals Hematologic Malignancies (HI) |
|
Oncology Orals Hematologic Malignancies (PR) |
|
Oncology Orals Solid Tumors (HI) |
|
Oncology Orals Solid Tumors (PR) |
|
Oncology Support Therapy (HI) |
|
Oncology Support Therapy (PR) |
|
Osteoarthritis (HI) |
|
Osteoarthritis (PR) |
|
Osteoporosis (HI) |
|
Osteoporosis (PR) |
P
|
PAH - Infusion (HI) |
|---|
|
PAH - Infusion (PR) |
|
PAH - Orals (HI) |
|
PAH - Orals (PR) |
|
PAH - Orenitram (HI) |
|
PAH - Orenitram (PR) |
|
Parkinson's (HI) |
|
Parkinson's (PR) |
|
Pomalyst-Revlimid-Thalomid (HI) |
|
Pomalyst-Revlimid-Thalomid (PR) |
|
Procrit (HI) |
|
Procrit (PR) |
Q
R
|
Remicade-Remicade Biosimilars (HI) |
|---|
|
Remicade-Remicade Biosimilars (PR) |
|
Renal (HI) |
|
Renal (PR) |
|
Respiratory Syncytia Virus (RSV) (HI) |
|
Respiratory Syncytial Virus (RSV) (PR) |
|
Retinal Disorders/Ocular Specialty (HI) |
|
Retinal Disorders/Ocular Specialty (PR) |
|
Rheumatology IV (HI) |
|
Rheumatology IV (PR) |
|
Rheumatology Orals Subcutaneous (HI) |
|
Rheumatology Orals Subcutaneous (PR) |
|
Ryplazim (HI) |
|
Ryplazim (PR) |
S
|
Sickle Cell Disease (HI) |
|---|
|
Sickle Cell Disease (PR) |
|
Sohonos (HI) |
|
Sohonos (PR) |
|
Sunlenca (HI) |
|
Sunlenca (PR) |
T
|
Transplant (HI) |
|---|
|
Transplant (PR) |
U
V
|
Vivitrol (HI) |
|---|
|
Vivitrol (PR) |
|
Vyvgart (HI) |
|
Vyvgart (PR) |
W
|
Wakix (PR) |
|---|
|
Wilson's Disease (HI) |
|
Wilson's Disease (PR) |
X
Y
Z
|
Zulresso (HI) |
|---|
|
Zulresso (PR) |
|
Zurzuvae (HI) |
|
Zurzuvae (PR) |
Disclaimers:
Enrollment forms must be sent by licensed health care providers. Not all prescription referrals require an enrollment form. New York and Iowa require providers to submit an electronic prescription.
This page contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers that are not affiliated with CVS Specialty.
This page contains trademarks or registered trademarks of CVS Pharmacy, Inc and/or one of its affiliates.
