CoverRx Application

CoverRx enrollment is open and new and re-enrollment applications are being accepted. The quickest way to
apply or reapply is by using the online application link below. You may also download, print, and complete a paper application by using the links below. Paper applications can be returned by mail or fax to the address or fax number
listed on the applications. Note: Please ONLY use the most recent paper applications that are available on this website. Please check back often because updates may have been made.

Online application:

Fillable paper applications: