Part D prescription drug claims
When you go to a network pharmacy, the pharmacy automatically submits your claim to us. However, if you have to go to an out-of-network pharmacy, the pharmacy may not be able to submit your claim directly to us.
You may use an out-of-network pharmacy if you:
- Are traveling outside your service area (within the United States) and run out of your medication, lose your medication or become ill, and you cannot access a network pharmacy.
- Are unable to obtain a covered drug in a timely manner because there is no network pharmacy within a reasonable driving distance that provides 24-hour service.
- Are trying to fill a prescription drug that is not regularly stocked at an accessible network retail or mail-order pharmacy.
- Receive a Part D drug dispensed by an out-of-network institutional-based pharmacy while you are a patient in the emergency department, a provider-based clinic, or an outpatient surgery or other outpatient setting.
- Have received your prescription during a state or federal disaster declaration or other public health emergency declaration in which you are evacuated or otherwise displaced from your service area or place of residence and cannot be reasonably expected to obtain covered Part D drugs at a network pharmacy.
In these situations, please check first with Member Services to see if there is a network pharmacy nearby. If you must use an out-of-network pharmacy, you will generally have to pay the full cost (rather than paying your normal share of the cost) when you fill your prescription. You can ask us to reimburse you for our share of the cost by sending us your request for payment, along with your pharmacy receipt documenting the payment you have made.
To make sure you are giving us all the information we need to make a decision, fill out our claim form to make your request for payment. To obtain a claim form, click the claim form for your plan below or call Member Services and ask for the form.
Part D prescription drug claim forms
Mail your request for payment together with any receipts to us at:
BCBSM Part D Claims Department
c/o Express Scripts Holding Company
P.O Box 14711
Lexington, KY 40512
Most of the time, doctors, hospitals and other health care providers submit claims directly to us. Occasionally, you may need to pay for a service out-of-pocket and seek reimbursement from us.
Member reimbursement form
This form is also called Member Application for Payment Consideration. Use this form if you've received covered medical services and are seeking reimbursement from us. This is most often used for flu shots.
When we receive your request for payment, we will let you know if we need any additional information. Otherwise, we will consider your request and decide whether to pay it and how much we owe. Contact us for more information if you have any other questions.