Prescription claim form

If you're asking for reimbursement for a prescription drug that's covered by your Medicare Plus Blue PPO plan, download and fill out this form:

Medicare Plus Blue Part D Prescription Drug Claims Form (PDF)

BCBSM Part D Claims Department
Express Scripts
ATTN: Medicare Part-D
P.O. Box 14718
Lexington, KY 40512
Fax to 608-741-5483