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 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
  • From the My Coverage dropdown, then click Prescription
  • Under Prescription links, click Prescription drug history. This will direct you the Express Scripts website
  • The Express Scripts website will open the Claims & balances page, click the blue Request Reimbursement button on the right
  • Follow the instructions on the page and click the blue Get Started button to begin submitting a claim

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

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