Walgreens Specialty Pharmacy Enrollment Form

Who is this for?

Michigan Health Insurance – Customer Service – Pharmacy

If you have prescription drug coverage through Blue Cross Blue Shield of Michigan or Blue Care Network, use this form to order your specialty drugs through the mail.

Specialty drugs require special handling, administration or monitoring. They’re used by people with chronic or difficult health conditions, like multiple sclerosis or rheumatoid arthritis.

Access the form here: Walgreens Specialty Pharmacy Enrollment 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.