Prescription Drug Mail Order Form BCBSMRX1

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 BCBSMRX1, use this form to order your medications through the mail from OptumRx®.

Access the form here: Rx group number BCBSMRX1 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: Is this your first time having your prescription filled by mail with Express Scripts? If so, you'll need to complete the Health, Allergy and Medical Questionnaire (PDF). Include this with your prescription drug mail order form when you mail it in.