This page contains forms pertaining to the prescription benefits available through the University of Kentucky health plans.

Form name Link to form
2017-18 Prescription Formulary (Active Employees and Pre-65 Retires)

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UK Medicare Carveout Prescription Formulary 2017

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UK Medicare Carveout Prescription Formulary 2018

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Medicare Rx EOC 2017

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Medicare Rx EOC 2018

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Mail Order Form – Active Employees and Pre-65 Retirees

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Mail Order Form – Medicare Retirees

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Manual Claim Form – Active Employees and Pre-65 Retirees

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Manual Claim Form – Medicare Retirees

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