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Blue Care Network Prescription Drug Mail Order Form

Who is this for?

If you have prescription drug coverage through Blue Cross Blue Shield of Michigan and your ID card has an Rx logo on it, use this form to order your medications through the mail from Express Scripts® through the Medco mail order pharmacy.

Access the form here: Medco prescription drug mail order form (PDF)

What you’ll need

Enrollee ID card
A prescription from your doctor
A printer to print the form
An envelope and postage to mail the form

If you have any questions, please contact us.

Tip: If you haven’t filled a prescription with Express Scripts by mail before, you’ll need to complete and include the Health, Allergy, and Medical Questionnaire (PDF).