Prescription Drug Reimbursement Claim Forms
Who is this for?
If you're a Blue Cross Blue Shield of Michigan member, use these forms if you've paid up front for prescription drugs that your insurance covers and you'd like to be reimbursed.
When you're getting a prescription filled, the pharmacy usually just bills us electronically.
However, sometimes you may have to pay up front for prescription drugs that your insurance covers. You can ask us to pay back that expense. Choose the appropriate form below.
- Most members will use this form: Prescription Drug Reimbursement Claim Form (PDF)
- Did you have a prescription filled in a foreign country and you paid up front? You'll need to fill out two forms: The Prescription drug foreign claim form (PDF) and the Prescription Drug Reimbursement Claim Form (PDF). Mail them to the address listed on the reimbursement form. That way, we'll have all the information we need to process your claim. Make sure to provide all information for each drug in English.
- Marketplace Subsidy members only: If you pay less each month because your government tax credit is paid to us, use this form: Health Insurance Marketplace Reimbursement Form (PDF)
What you’ll need
- Blue Cross ID card
- Pharmacy receipts
- A copier or scanner to make copies of receipts for you to keep
- A printer to print the form
- An envelope and postage to mail the form
If you have any questions, call the number on the back of your Blue Cross ID card, or contact us.