Getting Started with PriceMDs TCCThank you for your interest in the PriceMDs Treatment Cost Containment program. Please provide us with your information below and a PriceMDs Nurse Navigator will be in touch with you soon.First Name *Last NameDate of Birth *Phone Number *Email Address *What is the name of your employer? *What is your relationship to insured?SelfSpousePartnerDependentWhat is your preferred method of communication? *PhoneEmailTextOtherIs there a preferred time to be reached?1201020304050607080910110030AMPMSelect a time.If other, please specifySkip if you already selected aboveMedication NameEnter your medication name.Strength(E.g. 40mg, 3ml etc.)Frequency of Use(E.g. Twice a day, once a week etc.)This is a new medication for me.*YesNo*PriceMDs cannot provide the first dose of any new medication.DateSubmit
