Plan Documents and Forms

Provider patient review inquiry

Enrollment and changes

  • Join Our Network
    Find out how to join our network and gain valuable provider resources.

Non-contracted providers

Pharmacy services

Blue Cross Blue Shield of Michigan:

Blue Care Network:

  • Custom Drug List
    Take a look at our custom drug list, also called a formulary, to find out what prescription medications are covered.
  • Custom Select Drug List
    The custom select drug list is for members with individual or small group health plans that meet the requirements of the Affordable Care Act.
  • Prior Authorization and Step Therapy Guidelines
    Learn how the Prior Authorization and Step-Therapy Guidelines can help reduce costs while maintaining quality pharmaceutical care.

Blue Cross Complete

Wellness plans

  • Physician Verification Form
    Use this form to request a medical waiver or update us on the progress of patients enrolled in a wellness plan.

Supply forms

  • Supply Forms
    Learn how to order general administrative materials if you're a Blue Care Network, Blue Cross Blue Shield of Michigan, dental, or vision and hearing provider.

Referrals

  • Referrals
    Get access to out of network referral forms and learn how to submit referrals electronically.