WEA Trust - Health Plan - Your Drug Plan

Prescription drug forms

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Dispense As Written Form
Use this form if you have a "dispense as written" (DAW) prescription for a brand-name drug. Your Trust health plan requires your physician to justify the medical need for a DAW brand-name prescription over its generic equivalent. We would also like your doctor to complete the optional MedWatch Form, which helps the FDA track occurrences where a medication's quality and effectiveness might be in doubt. After a doctor completes the DAW form, it must be returned to us, preferably by fax.

Fax number:
(608) 276-9119

Mailing address:
WEA Trust
Pharmacy Services Preauthorization
P.O. Box 7338
Madison, WI 53707-7338

	Mail Order Form To save time, print the Mail Order Form and send the completed form and prescription to:
	Caremark P.O. Box 3223 Wilkes Barre, PA 18773-3223

	Coordination of Benefits Prescription Drug Claim Form Use this form to submit claims under coordination of benefits (secondary coverage) rules. After completing the form, send it to the following address: Caremark P.O. Box 52136 Phoenix, AZ 85072-2136
	Prescription Claim Form Use this form if you have paid for a prescription out of pocket. After completing the form, send it to the following address: Caremark P.O. Box 52136 Phoenix, AZ 85072-2136
	Foreign Claim Form Use this form for prescriptions that were purchased outside the United States or on a cruise ship. After completing the form, send it to the following address: Caremark P.O. Box 52136 Phoenix, AZ 85072-2136

Drug preauthorization
Prescription Drug Lists
Home Delivery Service
Your Pharmacy Tools
Drug Coverage
Learn About Generics
Ask a Pharmacist
OTC Drug Coverage
Speciality Pharmacy
Tablet Splitting

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