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Prescription Drug Mail Order Form BCBSMAN

Who is this for?

Michigan Health Insurance – Customer Service – Pharmacy

If you have prescription drug coverage through Blue Cross Blue Shield of Michigan and your ID card has the RX group number BCBSMAN, use this form to order your medications through the mail from Express Scripts®.

Access the form here: Rx group number BCBSMAN 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.

Tip: If you haven’t filled a prescription with Express Scripts® by mail before, you’ll need to complete and include the Health, Allergy, and Medical Questionnaire. You can get that form by logging into your Express Scripts online account. Under Prescriptions & Benefits in the left-hand column, click Forms.

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