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Scription. Fax the completed form to OptumRx at 800-853-3844. OptumRx will notify you and your patient of prescription approval. This form helps UnitedHealthcare determine if the patient s condition meets our drug policy guidelines. If you have questions or need to request a refill, please contact OptumRx at 866-815-5338. Please fill out the form completely. Any missing information may cause a delay in the approval. Fax: 800-853-3844 Phone: 866-815-5338 For all REFILL requests, please call.

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