Personal Medication List

Who is this for?

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If you're part of our Medication Therapy Management program, you can use this list to keep track of the prescription drugs you're taking.

Our Medication Therapy Management program is for people managing multiple chronic conditions and taking many prescription drugs. It helps you get the best results from your medications.

After we've talked to you about the medications you take, we'll send you a list based on our conversation.

You can also download and fill out the blank personal medication list below for personal use. It can help you and your doctors keep track of the medications you're taking.

The list helps our pharmacists and qualified pharmacy staff catch any potential problems or gaps. If we find an issue, we'll contact you or your doctor.

Personal medication list:

Download and fill this out:

Mail to:

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MTM Program — Mail Code TC 1308
P.O. Box 807
Southfield, MI 48037

Call:

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Call the number on the back of your Blue Cross ID card.
TTY users should use 711.