Using the mail order pharmacy service for your ongoing prescription drugs is easy, convenient and can save you money.
You can order up to a 90-day supply of your Tier 1, 2, 3 and 4 drugs or up to a 31-day supply of Tier 5 drugs from our network mail-order pharmacies.
For questions about your copays or what tier your drug is in, please refer to your Drug Formulary or call Express Scripts® or Walgreens mail-order pharmacy (see contact information below).
You are not required to use mail-order prescription drug services to obtain your extended supplies of maintenance medications. However, mail-order pharmacies often charge less and offer more convenience.
If your retail pharmacy agrees to accept the mail-order reimbursement rate for an extended supply of medications, your cost will be the same as the mail-order pharmacy. If your retail pharmacy does not agree to match the mail-order reimbursement rate, you are liable for the cost difference.
How to start:
Print the appropriate mail order pharmacy form below or call the contact number below to request a Mail-Order Kit. We contract with Express Scripts and Walgreens mail-order pharmacies. Select a mail-order pharmacy and fill out the Member Information section and the Patient Information section for each new prescription you send. If you are enrolling in Express Scripts mail-order pharmacy, also be sure to fill out and mail in the plan-specific Health, Allergy and Medication Questionnaire the first time you use your mail-order benefit.
Enclose your doctor's signed prescription form. Fill out the credit card section on the form or include your check or money order for the required copay. For more details about your prescription drug cost-share amounts, refer to your Evidence of Coverage or Summary of Benefits. It generally takes five days to process your order and mail it to you.
Getting refills for your prescription is easy. Just call the mail-order pharmacy service number or order online by referencing the prescription (Rx) number listed on your drug container. See contact information below. It's always a good idea to order your refills at least two weeks before your prescription runs out.
Express Scripts® pharmacy
24 hours a day, seven days a week
Express Scripts mail-order pharmacy forms and questionnaires
- Medicare Plus BlueSM PPO Mail-Order Pharmacy form (PDF)
- Medicare Plus BlueSM PPO Health, Allergy and Medication Questionnaire (PDF)
- Prescription BlueSM PDP Mail-Order Pharmacy form (PDF)
- Prescription BlueSM PDP Health, Allergy and Medication Questionnaire (PDF)
- Medicare Plus BlueSM Group PPO Mail-Order Pharmacy form (PDF)
- Medicare Plus BlueSM Group PPO Health, Allergy and Medication Questionnaire (PDF)
- Prescription BlueSM Group PDP Mail-Order Pharmacy form (PDF)
- Prescription BlueSM Group PDP Health, Allergy and Medication Questionnaire (PDF)
Walgreens mail- and fax-order pharmacy program
For use by individual plan members for the Walgreens Mail and Fax Order Pharmacy program.
- Walgreens Mail Order and Registration form for Medicare Plus BlueSM PPO (PDF)
- Walgreens Mail Order and Registration form for Prescription BlueSM PDP (PDF)
- Walgreens Fax Order form for Medicare Plus BlueSM PPO (for physician use only) (PDF)
- Walgreens Fax Order form for Prescription BlueSM PDP (for physician use only) (PDF)