Now Offering Affordable Self-Pay Options!

IUD Order Form

All Major Commercial and Medicaid Plans Accepted
*some 3rd party HMOs excluded

*UHC insurance is temporarily not accepted.


Please Complete All Sections

*MyIUDSupply will contact the patient for order confirmation

IMPORTANT: Prescriber gives express permission to use his/her NPI number included herein for the purpose of identifying the referring prescriber to the authorized pharmacy benefits manager and/or payer. accepts no liability regarding any decisions concerning claims, coverage or payment, which are made in the sole discretion of the health plan administrators and insurers. makes no assurance that any prescribed drug will be covered or reimbursed at any specific level under any patient’s insurance plan, or that any specific pharmacy will provide the prescribed drug.

Please check your email for your order confirmation


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