Prescription Drug Reimbursement Claim Forms

Who is this for?

Michigan Health Insurance – Customer Service – Documents and Forms

If you're a Blue Cross Blue Shield of Michigan member, use these forms if you've paid up front for prescription drugs that your insurance covers and you'd like to be reimbursed.

When you're getting a prescription filled, the pharmacy usually just bills us electronically.

However, sometimes you may have to pay up front for prescription drugs that your insurance covers. You can ask us to pay back that expense. Choose the appropriate form below.

You can still submit claims for prescription drug expenses in 2021. Use the appropriate form below.

What you’ll need

  • Blue Cross ID card
  • Pharmacy receipts
  • A copier or scanner to make copies of receipts for you to keep
  • A printer to print the form
  • An envelope and postage to mail the form

You may also request reimbursement for your prescription electronically. Follow the instructions below to submit your claim online.

  • Log in to your member account on our website
  • Click Forms
  • Click Reimbursement Form
  • Click Online Form
  • Verify your contact information
  • Click Prescription and follow the prompts to submit your online claim

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