Enrollment Forms

Enrollment forms

Step 1

Write prescription or

Select and download an Enrollment Form

Step 2

OR

Call

1-800-237-2767 or any
CVS Pharmacy

OR

E-Prescribe

CVS Specialty or any
CVS Pharmacy
(Prescribers Only)

Fax

1-800-323-2445 or any
CVS Pharmacy
(Prescribers Only)

Specialty Drug List

When you make a referral to CVS Specialty, you'll have access to over 99% of specialty therapies. View drugs

Step 1: Choose Location

U.S.

Step 2: Select the starting letter of the specialty therapy/condition or medication.

ABCDEFGHIJKLMNOPQRSTUVWXYZ

A

Acromegaly 

Alpha1 Proteinase Inhibitor Deficiency 

Aranesp 

Asthma 

B

C

CAPS Syndrome 

Cystic Fibrosis 

D

Dermatitis - Atopic 

Dermatology/Psoriasis 

Doptelet 

E

F

Fertility 

Forteo 

G

Gastroenterology 

General CVS Specialty Enrollment Form 

Growth Hormone Disorders 

H

Hematopoietic: Hepatitis C 

Hematopoietics 

Hemophilia 

Hepatitis C 

Hereditary Angioedema - Haegarda Dosing 

Hereditary Angioedema - Haegarda HUB 

HIV 

Hydroxyprogresterone Caproate 

I

Idiopathic Pulmonary Fibrosis 

Idiopathic Pulmonary Fibrosis – Ofev 

Immune Disorders (General and IVIG) 

Inflammatory Bowel Disease 

J

K

L

Liletta 

LupronDepot - Eligard-Zoladex-Firmagon 

Lupron Gynecology Women's Health 

Lupron Pediatric 

Lupus 

Lysosomal Storage Disorders 

M

Makena 

Migraine 

Mirena/Skyla/Kyleena 

Mirena/Skyla/Kyleena - LA Medicaid 

Multiple Sclerosis 

Multiple Sclerosis Infusion 

N

Nuzyra 

O

Oncology General 

Oncology Infused Medications 

Oncology Orals Hematologic Malignancies 

Oncology Orals Medications 

Oncology Orals Solid Tumors 

Osteoarthritis 

Osteoporosis 

Oxbryta 

P

Parkinson's 

Pomalyst/Revlimid/Thalomid 

Procrit 

Pulmonary Arterial Hypertension Infusion 

Pulmonary Arterial Hypertension Orals 

PAH - Adempas 

PAH - Adempas REMS 

PAH - Opsumit PLUS 

PAH - Opsumit - PSMN 

PAH - Opsumit REMS 

PAH - Orenitram 

PAH – Remodulin Pre-Mix 

PAH - Tracleer - PSMN 

PAH - Tracleer - REMS 

PAH - Treprostinil Injection 

PAH - Treprostinil Premix 

PAH - Tyvaso-Remodulin 

PAH - Uptravi 

Q

R

Respiratory Syncytial Virus (RSV) 

Retinal Disorders/ Ocular Specialty 

Rheumatoid Arthritis 

Rheumatology IV 

Rheumatology Subcutaneous 

S

SCC-ILD-OFEV 

Soliris 

South Carolina General Form 

T

Takhzyro Commercial Start 

Takhzyro Quick Start 

Transplant 

U

Urology Oral Medications 

V

Vitrakvi 

Vivitrol 

W

Wilson Disease 

X

X-linked Hypophosphatemia - Crysvita 

Y

Z

Zulresso