Pharmacy and Drug Coverage Forms
Who is this for?
If you have a Medicare health or drug plan with the Blues, these forms can help you manage and order prescription drugs.
Do you need to order prescription drugs through the mail? Are you in our Medication Therapy Management program? Or do you need help paying for a drug we don't cover? Use the forms below.
- Mail order drug forms
You can use these forms to order your prescription drugs through the mail.
- Personal medication lists
If you're part of our Medication Therapy Management program, these are the forms to list the drugs you're taking.
- Prescription drug coverage determination forms
You can use these forms to ask us to cover medications that aren't on drug plan lists.