Blue Care Network Prescription Drug Mail Order Form

Who is this for?

Michigan Health Insurance – Customer Service – Pharmacy

If you have prescription drug coverage through your HMO with Blue Care Network, use this form to order your medications through the mail from Express Scripts®.

Access the form here: Express Scripts 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).