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PDF Providers Forms

Prescription Enrollment forms by disease state (print versions):

This section is for providers only. Kindly, download the enrollment form, and complete the appropriate information and fax directly to Commcare. Providers that would like to e-prescribe may feel free to do so.


In today’s world of managed care, complying with the rules and regulations of diverse insurance companies can be difficult. In order to make this process easier for prescribers, Commcare Specialty Pharmacy has developed an automated computer system that continually tracks the progress of prior authorization(PA) requests. This system is capable of ensuring that your prior authorization(PA) request is performed as quickly as possible, with minimal impact on you and your patients.

In instances where the cost of a medication is prohibitive, we accept copayment vouchers from many not-for-profit agencies. We also maintain a comprehensive list of manufacturer patient assistance programs and are always willing to aid patients in completing the necessary paperwork.

Our computer systems integrate with Surescripts and most other modern e-prescription software. For your convenience, we accept e-prescriptions and also have the ability to generate electronic refill requests. If you do not see Commcare Specialty Pharmacy in your list of targets, contact us so we can integrate our systems into yours.

As part of our Assist disease-state management programs, we have designed graphical medication compliance reporting for prescribers and their patients. These reports can be used as an aid in identifying and counseling patients who have not been adherent to their prescribed drug regimen. For more information on our compliance reporting, or to receive sample compliance reports, please contact your local Commcare Specialty Pharmacy service representative.