Blue Care Network Prescription Drug Mail Order Form
Who is this for?

If you have prescription drug coverage through your HMO with Blue Care Network, use this form to order your medications through the mail from Express Scripts®.
Access the form here: Express Scripts prescription drug mail order form (PDF)
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, please contact us.
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