The BadgerRx Gold Program enrollment kit contains the same important information that is provided on this website. You will receive a brochure explaining the program, an enrollment form and a partial list of covered medications. We also provide you with a postage-paid return envelope for your convenience.

You can obtain an enrollment kit by calling our BadgerRx Gold hotline at 866-809-9382 (8am to 5pm Central time, M-F), by downloading the enrollment form and brochure as a PDF file, or by completing the mailing information form below.

If you would like to download a PDF file of either the enrollment form and/or the enrollment brochure now, you will need the free Adobe Acrobat Reader software. If you do not have Adobe Acrobat Reader, you can obtain it now at http://www.adobe.com/products/acrobat/readstep2.html

If you would like an enrollment kit mailed to you, please complete the following information.