Part D Claim Form

Beginning 2024

For Medicare Part D drug claims, please complete this Navitus Health Solutions claim form and mail with receipts to:

Navitus Health Solutions Manual Claims
PO Box 1039
Appleton, WI 54912-1039

Or

Fax completed form with receipts to: 1-855-668-8550

2023 and prior years

For Medicare Part D drug claims, please complete this Express Scripts claim form and mail with receipts to:

Express Scripts
ATTN: Medicare Part D
PO Box 14718
Lexington, KY 40512-4718

Or

Fax completed form with receipts to: 1-608-741-5483