Dedicated to providing quality pharmacy benefits to patients as a team.

Providers, please submit new prescriptions to Maxor Pharmacies:

Please fax the new prescription to the following number: 1(866) 589-7656

Submit the prescription electronically to the following NCPDP IDs:

Maxor Mail Order Pharmacy – 4599037
Maxor USFHP/DOD Mail Order Pharmacy - 9100099

Pharmacies, if you would like to be added to the MaxorPlus Pharmacy Provider Network:

Please contact us via email:


MaxorPlus Standard Prior Authorization form

This form can be used for general purposes, to be completed by the physician or nursing staff and signed by the physician. If you would prefer a form that is more drug/therapy specific or have any questions related to this standard form or the prior authorizations process, please call 1(800) 687-0707 and ask to speak to one of the clinical team.

Download Form (PDF)



Common Questions

Get more information regarding your prescription benefit and mail order pharmacy services.