Prescription Drug Reimbursement Claim Forms
Who is this for?
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.
- Prescription Drug Reimbursement Claim Form (PDF)
- Marketplace Subsidy members only: If you pay less each month because your government tax credit is paid to us, use this form: Health Insurance Marketplace Reimbursement Form (PDF)
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
- On the Prescription page, click the blue Go to Express Scripts button
- The Express Scripts website will open, click Benefits and select Forms from the drop-down tab
- On the Forms page scroll down to Request Reimbursement and click the blue Start a Claim button
- Follow the instructions on the Get Reimbursed page and click the blue Get Started button when you are ready to begin your online 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.