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 have your medications delivered to your home.

Prescription drugs

Take advantage of your pharmacy benefits and enroll in our home delivery service.

We want you to get the most value from your Blue Cross Blue Shield of Michigan and Blue Care Network prescription drug plan. Use the Optum new home delivery prescription order form to order and get prescription drugs by mail.

What you’ll need

  • Enrollee ID card
  • A prescription from your doctor
  • A printer to print the form
  • An envelope and postage to mail the form

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

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 Walgreen Pharmacy delivery. For more information, call 1-866-515-1355 or visit For a current list of specialty drugs in this program, see the Specialty Drug Program Rx Benefit Member Guide (PDF).