Prescription Referral Forms

This section is for prescribing practitioners only. Patients must bring an original prescription to the pharmacy, and cannot fax these referral forms. Faxed prescriptions will only be accepted from a licensed practitioner.

Once we receive the completed referral form, the altScripts Specialty team will:

  • Verify insurance coverage and file the claim with the insurance provider.
  • Provide prior authorization and financial assistance support to ensure patient access.
  • Notify the patient and physician of the prescription status.
  • Contact the patient to coordinate pick-up or delivery of the medication.
  • Pharmacist will discuss with the patient their medication(s), how to maintain adherence, monitor and report side effects.