account.covermymeds.com
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Submitted URL: https://www.covermymeds.com/request/view/BXTYA3YE
Effective URL: https://account.covermymeds.com/?destination_url=https%3A%2F%2Fwww.covermymeds.com%2Frequest%2Fview%2FBXTYA3YE
Submission: On May 04 via manual from US — Scanned from DE
Effective URL: https://account.covermymeds.com/?destination_url=https%3A%2F%2Fwww.covermymeds.com%2Frequest%2Fview%2FBXTYA3YE
Submission: On May 04 via manual from US — Scanned from DE
Form analysis 2 forms found in the DOM
Name: login — POST /login
<form accept-charset="UTF-8" id="login-form" name="login" action="/login" method="post" class="login-form" autocomplete="off">
<input type="hidden" name="authenticity_token" id="authenticity_token" value="0k5nW5FmlDyl/4jr11E1W+gs9Df7XxFqVPKgsq8D3lsoxz9zQSTRtgZ+ymHFyxqMjR+yMdDeolKpl2OQrRVo5g==">
<input class="form-name" name="name" type="hidden" value="form__login">
<input class="form__catch--1" name="form__catch--1" style="display: none;" type="text">
<span class="form__catch--1"> Do not fill out this field</span>
<input class="form__catch--2" name="form__catch--2" type="checkbox" value="clicked"><span class="form__catch--2"> Do not check this checkbox</span>
<div class="js-field-wrapper mdc-text-field style--width-100 mdc-text-field--upgraded mdc-text-field--focused" id="username-field" data-mdc-auto-init="MDCTextField">
<input type="text" name="username" id="username" class="mdc-text-field__input" maxlength="200" autocomplete="off" data-validate="["required"]" data-name="Your username" aria-required="true">
<label class="mdc-floating-label mdc-floating-label--float-above" for="username">Username</label>
<div class="mdc-line-ripple mdc-line-ripple--active"></div>
</div>
<div class="js-field-wrapper mdc-text-field style--width-100 mdc-text-field--upgraded" id="password-field" data-mdc-auto-init="MDCTextField">
<input type="password" name="password" id="password" class="mdc-text-field__input" autocomplete="off" data-validate="["required"]" data-name="Your password" aria-required="true">
<label class="mdc-floating-label" for="password">Password</label>
<div class="mdc-line-ripple"></div>
</div>
<div class="spacer__top--medium">
<input type="submit" name="commit" value="Log in" id="login-button" class="mdc-button mdc-button--raised style--width-100 spacer__bottom--small secondary-filled-button" data-disable-with="Log in">
<p class="style--center style--uppercase">
<a class="style--magenta" href="/forgot">Forgot your username or password?</a>
</p>
</div>
</form><form class="CMC-message-input"><textarea id="CMC-message-form" placeholder="Type here and hit <enter> to chat"></textarea></form>Text Content
About Solutions News & Insights Support Careers | Enter Key Create a Free Account LOG IN WELCOME BACK! Log into your CoverMyMeds account to create new, manage existing and access pharmacy-initiated prior authorization requests for all medications and plans. Need help? Visit our support page. Please note: CoverMyMeds requires a browser feature called JavaScript for full functionality. All modern browsers support JavaScript. Please see How to enable JavaScript in your browser, or contact help@covermymeds.com with any additional questions or concerns. LOG IN Do not fill out this field Do not check this checkbox Username Password Forgot your username or password? ^_Click to Chat with CoverMyMeds Questions? We're right here! Type to chat with us.