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

Puerto Rico and Hawaii

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

ABCDEFGHIJKLMNOPQRSTUVWXYZ

A

Acromegaly (Hawaii) 

Acromegaly (Puerto Rico) 

Alpha 1 Proteinase Inhibitor Deficiency (Hawaii) 

Alpha1 Proteinase Inhibitor Deficiency (PR) 

Aranesp (Hawaii) 

Aranesp (Puerto Rico) 

Asthma (Hawaii) 

Asthma (Puerto Rico) 

B

C

CAPS Syndrome (Hawaii) 

CAPS Syndrome (Puerto Rico) 

Cystic Fibrosis (Hawaii) 

Cystic Fibrosis (Puerto Rico) 

D

Dermatitis - Atopic (Hawaii) 

Dermatitis - Atopic (Puerto Rico) 

Dermatology/Psoriasis (Hawaii) 

Dermatology/Psoriasis (Puerto Rico) 

E

F

Fertility (Hawaii) 

Fertility (Puerto Rico) 

Forteo (Hawaii) 

Forteo (Puerto Rico) 

G

Gastroenterology (Hawaii) 

Gastroenterology (Puerto Rico) 

General CVS Specialty Enrollment Form (HI) 

General CVS Specialty Enrollment Form (PR) 

Growth Hormone Disorders (Hawaii) 

Growth Hormone Disorders (Puerto Rico) 

H

Hematopoietic: Hepatitis C (Hawaii) 

Hematopoietic: Hepatitis C (Puerto Rico) 

Hematopoietics (Hawaii) 

Hematopoietics (Puerto Rico) 

Hemophilia (Hawaii) 

Hemophilia (Puerto Rico) 

Hepatitis C (Hawaii) 

Hepatitis C (Puerto Rico) 

Hereditary Angioedema - Haegarda Dosing (HI) 

Hereditary Angioedema - Haegarda Dosing (PR) 

Hereditary Angioedema - Haegarda HUB (HI) 

Hereditary Angioedema - Haegarda HUB (PR) 

HIV (Hawaii) 

HIV (Puerto Rico) 

Hydroxyprogesterone Caproate (Hawaii) 

I

Idiopathic Pulmonary Fibrosis (Hawaii) 

Idiopathic Pulmonary Fibrosis (Puerto Rico) 

Immune Disorders (General and IVIG) (HI) 

Immune Disorders (General and IVIG) (PR) 

Inflammatory Bowel Disease (HI) 

Inflammatory Bowel Disease (PR) 

J

K

L

LupronDepot - Eligard-Zoladex-Firmagon (HI) 

LupronDepot - Eligard-Zoladex-Firmagon (PR) 

Lupron Gynecology Women's Health (HI) 

Lupron Gynecology Women's Health (PR) 

Lupron Pediatric (Hawaii) 

Lupron Pediatric (Puerto Rico) 

Lupus (Hawaii) 

Lupus (Puerto Rico) 

Lysosomal Storage Disorders (HI) 

Lysosomal Storage Disorders (PR) 

M

Makena (Hawaii) 

Makena (Puerto Rico) 

Migraine (Hawaii) 

Migraine (Puerto Rico) 

Multiple Sclerosis (Hawaii) 

Multiple Sclerosis (Puerto Rico) 

Multiple Sclerosis Infusion (HI) 

Multiple Sclerosis Infusion (PR) 

N

Nuzyra (Hawaii) 

Nuzyra (Puerto Rico) 

O

Oncology - General (Hawaii) 

Oncology - General (Puerto Rico) 

Oncology Infused Medications (HI) 

Oncology Infused Medications (PR) 

Oncology Orals Hematologic Malignancies (HI) 

Oncology Orals Hematologic Malignancies (PR) 

Oncology Oral Medications (Hawaii) 

Oncology Oral Medications (Puerto Rico) 

Oncology Orals Solid Tumors (Hawaii) 

Oncology Orals Solid Tumors (Puerto Rico) 

Osteoarthritis (Hawaii) 

Osteoarthritis (Puerto Rico) 

Osteoporosis (Hawaii) 

Osteoporosis (Puerto Rico) 

P

Parkinson's (Hawaii) 

Parkinson's (Puerto Rico) 

Pomalyst/Revlimid/Thalomid (Hawaii) 

Pomalyst/Revlimid/Thalomid (Puerto Rico) 

Procrit (Hawaii) 

Procrit (Puerto Rico) 

Pulmonary Arterial Hypertension Infusion (HI) 

Pulmonary Arterial Hypertension Infusion (PR) 

Pulmonary Arterial Hypertension Orals (HI) 

Pulmonary Arterial Hypertension Orals (PR) 

PAH - Orenitram (Hawaii) 

PAH - Orenitram (Puerto Rico) 

PAH - Tyvaso-Remodulin 

Pulmonary Arterial Hypertension - Orenitram 

Q

R

Respiratory Syncytial Virus (RSV) (Hawaii) 

Respiratory Syncytial Virus (RSV) (Puerto Rico) 

Retinal Disorders/Ocular Specialty (HI) 

Retinal Disorders/Ocular Specialty (PR) 

Rheumatology (Hawaii) 

Rheumatology (Puerto Rico) 

Rheumatology IV (Hawaii) 

Rheumatology IV (Puerto Rico) 

Rheumatology Subcutaneous (HI) 

Rheumatology Subcutaneous (PR) 

S

Sickle Cell Disease (HI) 

Sickle Cell Disease (PR) 

Soliris (Hawaii) 

Soliris (Puerto Rico) 

Spravato_HI 

Spravato_PR 

T

Transplant (Hawaii) 

Transplant (Puerto Rico) 

U

Urology Oral Medications (Hawaii) 

Urology Oral Medications (Puerto Rico) 

V

Vivitrol (Hawaii) 

Vivitrol (Puerto Rico) 

W

X

Y

Z

Zulresso (HI) 

Zulresso (PR)