• Format: (000) 000-0000.
  • Do you have Medicare Part D Drug coverage?*

  • Mosaic Pharmacy Service is only available those who need extra assistance and take multiple medications. Please choose the answer that best describes your life today.

  • How many medications are you currently taking?*
  • Personal Care (bathing, dressing, grooming, bathroom)*
  • Mobility (bed/chair, walking, stairs)*
  • Daily Living Tasks (driving, eating, managing medications)*
  • Home and Community Tasks (meal prep, housecleaning, using a computer)*

  • ⚠ Please review your answers
    You selected “I never need help” in three or more areas. If these answers are correct, you won't be eligible for Mosaic. If you need help in any of these areas, please update your answers before continuing.

  • You’re almost finished!
    Based on the insurance plan you selected, you do not need to complete the full intake form right now. Click Submit below to send us your information and we will reach out to you.

  • Good news! Based on your answers, it looks like you may qualify for Mosaic Pharmacy Service. However, we need to ask a couple more questions to make sure.

  • Would you like to continue with enrollment?

  • By pressing submit, you are providing consent for us to use your email and phone number for Mosaic to reach out relating to Mosaic opportunities. If you elect to submit your contact information, you can opt out by providing notice to us. Please read our privacy policy and notice of privacy practices for more information.

    If you don't wish to submit your contact information, please click back or navigate away from this page.

    We protect and encrypt your data.

  • Based on your responses, we need more information to know if you qualify for Mosaic. Please call (800) 510-5989 to find out if we can serve you. 

    Here are some of the Mosaic benefits that we offer:

    • Talk to a Mosaic pharmacist 24/7 about any symptoms or concerns
    • Take daily pill pouches clearly labeled by date and time
    • Get a 30-day supply medication box delivered to your door
    • Always get the lowest cost medications from your copay
    • Have a pharmacist evaluate any duplicate medications
    • Mosaic will work with your providers and health plans for treatment

     

    By pressing submit, you are providing consent for us to use your email and phone number for Mosaic to reach out relating to future Mosaic opportunities. If you elect to submit your contact information, you can opt out by providing notice to us. Please read our privacy policy and notice of privacy practices for more information.

    If you don't wish to submit your contact information, please click back or navigate away from this page.

    We protect and encrypt your data.

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