Already a Member?

Login as a:

Member
Employer
Provider
Agent

Not Registered? Get access to your member portal. Register Now

Browse by Topic

Browse by Plan Type:

Other Help

Not finding what you need in this section for members and insurance shoppers? Check out our other help sections below.

Prescription Drug Mail Order Form BCBSMAN

Who is this for?

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

Access the form here: Rx group number BCBSMAN 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. You can get that form by logging into your Express Scripts online account. Under Prescriptions & Benefits in the left-hand column, click Forms.