Plan Sales: 888-492-8633 (TTY 711)
Current Members: 800-782-8633 (TTY 711)
Hours: 8am-8pm, 7 days a week
Access Forms for Medicare Members
AvMed makes it easy to manage your coverage and care by providing forms and other tools. Simply print and complete one of our pre-composed forms for quick, easy service. Certain requests can be submitted directly online.
AvMed Medicare Pre-Enrollment Checklist
AvMed Medicare Enrollment Form
AvMed Medicare Formulario para Inscripción
Appointment of Representative (Medicare Members)
Designated Record Set (DRS) Request Form
Medicare Complaint Form
Member Disclosure Form
Medicare Rx Mail Order Form
Medicare Rx Mail Order Form - Spanish
Medication Exception Request Form
Model CMS Drug Determination Request Forms
Medical Direct Member Reimbursement Form
Mental Health Direct Member Reimbursement Form
Pharmacy Member Reimbursement Form - AvMed pharmacy reimbursements are processed by CVS Caremark.
Filing a Complaint - How to file a complaint with the Office of Civil Rights or the Federal Trade Commission.
Member FAQs - Information related to the factors enrollees should consider in selecting a health information management application.
Privacy Rights - Strategies enrollees may use to safeguard the privacy and security of their data.
Quality Assurance Drug Management Programs
AvMed provides quality assurance programs to ensure you receive safe and efficient care.
Drug Utilization Review
Medication Therapy Management (MTM)
Personal Medication List
Personal Medication List - Spanish
2023 Part D Prior Authorization Criteria
2023 Step Therapy Criteria
Part D Transition Policy