Plan Documents and Forms

Enrollment and changes

  • Join Our Network
    Find out how to join our network and gain valuable provider resources.

Non-contracted providers

Chart requests

  • Medical Record Retrieval and Review
    Learn about the medical record retrieval and review process. Ciox Health is our vendor for medical chart retrieval requests for commercial and Medicare Advantage members.

Pharmacy services

Commercial Blue Cross Blue Shield of Michigan and Blue Care Network

  • Clinical Drug List
    The clinical drug list is updated twice a year and provides a list of drugs covered by our plans.
  • Custom Drug List
    The custom drug list is a prescription resource for members with three-tier or closed drug list plans.
  • Custom Select Drug List
    The custom select drug list is for members with individual or small group health plans that meet the requirements of the Affordable Care Act.
  • Preferred Drug List
    To find out what drugs are the most safe and least expensive, read our preferred drug lists for Blue Cross Blue Shield of Michigan members.

Medicare Part D– Blue Care Network Advantage and Medicare Plus Blue PPO

Medicare Plus Blue PPO and Prescription Blue PDP Formularies
Find out what prescription drugs are covered under Medicare Plus Blue PPO and Prescription Blue PDP.

BCN Advantage HMO-POS formulary

Beers Drug List

Pharmacy Provider Information
Get important information about Medicare Part D.

Blue Cross Complete

Wellness plans

  • Physician Verification Form
    Use this form to request a medical waiver or update us on the progress of patients enrolled in a wellness plan.

Supply forms

  • Supply Forms
    Learn how to order general administrative materials if you're a Blue Care Network, Blue Cross Blue Shield of Michigan, dental, or vision and hearing provider.


  • Referrals
    Get access to out of network referral forms and learn how to submit referrals electronically.