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Form analysis
2 forms found in the DOM

POST /web/login

<form novalidate="novalidate" method="POST" action="/web/login" data-se="o-form" slot="content" id="form1" class="primary-auth-form o-form o-form-edit-mode">
  <div data-se="o-form-content" class="o-form-content o-form-theme clearfix">
    <h2 data-se="o-form-head" class="okta-form-title o-form-head">Sign In</h2>
    <div class="o-form-error-container" data-se="o-form-error-container"></div>
    <div class="o-form-fieldset-container" data-se="o-form-fieldset-container">
      <div data-se="o-form-fieldset" class="o-form-fieldset o-form-label-top margin-btm-5">
        <div data-se="o-form-label" class="okta-form-label o-form-label"><label for="okta-signin-username">USERNAME&nbsp;</label></div>
        <div data-se="o-form-input-container" class="o-form-input"><span data-se="o-form-input-username" class="o-form-input-name-username o-form-control okta-form-input-field input-fix"> <input type="text" placeholder="" name="username"
              id="okta-signin-username" value="" autocomplete="username" required=""> </span></div>
      </div>
      <div data-se="o-form-fieldset" class="o-form-fieldset o-form-label-top margin-btm-30">
        <div data-se="o-form-label" class="okta-form-label o-form-label"><label for="okta-signin-password">PASSWORD&nbsp;</label></div>
        <div data-se="o-form-input-container" class="o-form-input"><span data-se="o-form-input-password" class="o-form-input-name-password o-form-control okta-form-input-field input-fix"> <input type="password" placeholder="" name="password"
              id="okta-signin-password" value="" autocomplete="current-password" required=""> </span></div>
      </div>
      <div data-se="o-form-fieldset" class="o-form-fieldset o-form-label-top margin-btm-0">
        <div data-se="o-form-input-container" class="o-form-input"><span data-se="o-form-input-remember" class="o-form-input-name-remember">
            <div class="custom-checkbox"><input type="checkbox" name="remember" id="input7"><label for="input7" data-se-for-name="remember">Remember me</label></div>
          </span></div>
      </div>
    </div>
  </div>
  <div class="o-form-button-bar"><input class="button button-primary" type="submit" value="GET STARTED" id="okta-signin-submit" data-type="save"></div>
</form>

POST https://ci32.actonsoftware.com/acton/forms/userSubmit.jsp

<form _ngcontent-c2="" accept-charset="UTF-8" action="https://ci32.actonsoftware.com/acton/forms/userSubmit.jsp" enctype="multipart/form-data" id="form_0018" method="post" novalidate="" class="ng-untouched ng-pristine ng-valid"><input
    _ngcontent-c2="" name="ao_a" type="hidden" value="3999"><input _ngcontent-c2="" name="ao_f" type="hidden" value="0018"><input _ngcontent-c2="" name="ao_d" type="hidden" value="0018:d-0001"><input _ngcontent-c2="" id="ao_p" name="ao_p"
    type="hidden" value="0"><input _ngcontent-c2="" id="ao_jstzo" name="ao_jstzo" type="hidden" value=""><input _ngcontent-c2="" name="ao_cuid" type="hidden" value=""><input _ngcontent-c2="" name="ao_srcid" type="hidden" value=""><input
    _ngcontent-c2="" id="ao_bot" name="ao_bot" type="hidden" value=""><input _ngcontent-c2="" name="ao_camp" type="hidden" value="">
  <div _ngcontent-c2="" class="field" id="ao_alignment_container"><input _ngcontent-c2="" id="form_0018_fld_0" name="Full Name" type="hidden" value="Guest"><label _ngcontent-c2="" for="form_0018_fld_1">YOUR EMAIL</label><input _ngcontent-c2=""
      autocomplete="email" class="mailing-input" id="form_0018_fld_1" inputmode="email" name="Email" placeholder="YOUR EMAIL" type="email" value="">
    <div _ngcontent-c2="" id="form_0018_ao_submit_button"><input _ngcontent-c2="" class="btn mailing-btn" id="form_0018_ao_submit_input" name="Submit" type="button" value="SUBMIT"></div>
  </div>
</form>

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IMPORTANT UPDATES


COVID-19.

We are closely monitoring the Coronavirus (COVID-19) and are working hard to
ensure you have the medicine you need.

Birdi patients: Due to high call volumes, we encourage you to manage your
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MEET MEDIMPACT.

MedImpact is a pharmacy benefit manager who works with your health plan to get
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The information on this site is not intended to replace the diagnosis and
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It is a resource to keep you up-to-date about your pharmacy benefit and help you
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Notice of Language Assistance: You can get an interpreter at no cost to talk to
you. To speak with an interpreter, please call the Member Services phone number
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FOR MEMBERS

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CLIENT RESOURCES

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Copyright © 2024 MedImpact. All rights reserved. Version 2.4.15 Released On 11,
April 2024