Member Self-Enrollment

STEP 1: Search For Your Medication

Please type the name of your medication in the field below and click search.


Looks like we may not carry that particular medication. Please send us a message or email to request it.

Medication IPP1
Enter A Medication To Search  

1 International Pharmacy Program

    Patient Information

    State *

    Date of Birth *

    (This is the employer of the covered family member who holds the insurance.)

    Prescription Information

    (This value cannot be changed. If this is the wrong medication refresh the page and start again.)

    Is this a new prescription for you? *

    Allergies (optional)

    Scan or Photo of Drivers License (optional)
    (file size limit: 5mb)

    Scan or Photo of Prescription (optional)
    (file size limit: 5mb)

    Other Medication(s) (optional)

    Thank you for submitting your enrollment form. A member advocate will be in touch shortly.

    Need Assistance?

    8:30am-5pm EST Weekdays

    If you need additional assistance, schedule a time to talk with one of our member avocates.
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