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To register, please take a few minutes to enter your information below. If you have been given the authority to care for another adult, please enter their personal and prescription plan information instead. If you have already registered with this site, there is no need to re-register, simply log in now.

Tell us about yourself.
First Name:
Last Name:
Date of Birth:   (mm/dd/yyyy)
Gender:

Tell us about your EnvisionRx member information.
Member ID:
  Your member ID may be obtained by calling
our customer service at 1-800-361-4542.
Cardholder's Last Name:   
Relationship:

Provide your e-mail address and create a password.
You will use this information to login and access your information each time you return to the site.
Email:
Create Password:
(Must be at least 6 characters. All passwords are cAsE-sEnSitiVE.)
Confirm Password:
(Retype your password exactly as you did above)
Secret Question:
Answer:

You may check here to permit your spouse or domestic partner to view your prescriptions and order on your behalf. This means your records will be available to that individual unless you revoke this access, which you can do at any time by updating your online profile.

Please note: If you check the option above, your spouse or domestic partner will have full access to your entire prescription history once he or she registers with this site. Access will remain in effect unless you update your online profile.

If you would like to view your spouse's or domestic partner's prescription history, he or she must register with this site to grant you this access.
Please enter the following information:
Full Name:
Title:
Contact Phone:
Contact Email:
Covered Entity Information:
Name:
Address 1:
Address 2:
City:
State:
Zip Code: