Prescription Drug Mail Order Form BCBSMAN

Who is this for?

Michigan Health Insurance – Customer Service – Pharmacy

If you have prescription drug coverage through Blue Cross Blue Shield of Michigan and your ID card has the RX group number 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: Is this your first time having your prescription filled by mail with Express Scripts? If so, you'll need to complete the Health, Allergy and Medical Questionnaire (PDF). Include this with your prescription drug mail order form when you mail it in.

©1996-2016 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. We provide health insurance in Michigan.

State and Federal Privacy laws prohibit unauthorized access to Member's private information. Individuals attempting unauthorized access will be prosecuted.

Site Map  |  Feedback  |  Important Legal and Privacy Information

BCBSM is an Accredited Business through the Better Business Bureau