Lopez Island Pharmacy (360)468-2616 Fax (360) 468-3825
Travel Medication Request
rev: 01/04/2022 HIPAA Compliant ver 1.2
This form is to request prescription medications above and beyond what your pharmacy insurance usually covers, i.e. multiple weeks/months of travel.
Not all insurance even allows what can be thought of as vacation overrides and some limit the number of overrides per year. It varies from insurance to insurance and can change at a moments notice.
Planning well ahead is your best bet to make sure you have enough medication for your trip. We need 7-10 a days advance notice to work on these requests.
We will need certain information in order for us to make sure you have what your need.