Pharmacy Support Intake

Thank you for contacting Key Health Care. If you were referred by 211, you are in the right place.

This brief form will help us collect the information needed to review available prescription prices and identify opportunities to reduce your out-of-pocket medication costs.

For the most accurate pricing review, please have your medication bottle, prescription label, pharmacy application, or other prescription record available. We may need the medication name, strength, form, quantity, days supplied, dosage instructions, and current pharmacy location. Providing complete information helps us research your prescription correctly the first time and make the best use of your time.

The lowest available price may require filling your prescription at a different participating pharmacy. We will present any available options for your consideration, and no pharmacy change or purchase will be made without your approval.

By submitting this form, you authorize Key Health Care to research available pricing using the prescription information you provide and to contact you if additional information is needed.

Please complete the form in one session, as your progress cannot be saved. You may print the information for reference or restart the form later if necessary.

Questions before or during the process? Call 888-320-5397 or email service@keyhealthcare.org. A receptionist will assist you initially and, when needed, connect you with a  support specialist or arrange for a return call.

Thank you for trusting Key Health Care to assist with your prescription-cost inquiry.