Mail Order Drug Forms

Who is this for?

Michigan Health Insurance – Customer Service – Documents and Forms

If you have prescription drug coverage through Blue Cross Blue Shield of Michigan or Blue Care Network, use these forms to order your medications through the mail.

If you have any questions, call the number on the back of your enrollee ID card, or please contact us.

Prescription drugs

Blue Cross Blue Shield of Michigan

Use the form that matches your Rx group number to order and get prescription drugs by mail.

Rx group number BCBSMAN mail order form
Rx group number BCBSMRX1 mail order form

Blue Care Network

Express Scripts® prescription drug mail order form

Medicare member?

You can find mail order drug forms on our Medicare website.

Specialty drugs

Blue Cross Blue Shield of Michigan and Blue Care Network members can get their specialty drugs by mail, through AllianceRx Walgreens Prime delivery. For more information, call 1-866-515-1355 or visit alliancerxwp.com. For a current list of specialty drugs in this program, see the Specialty Drug Program Rx Benefit Member Guide (PDF).