Prescription Drug Reimbursement Claim Forms

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)

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.

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