Prescription Drug Guides and Forms

Get the most from your prescription drug coverage with these helpful guides for both you and your doctor. Use the forms to file claims and request changes.

These forms are available as PDF files. Just click on the appropriate form to view, download and print. You will need the Adobe^® Reader^® to access these files, which you can download for free at Adobe's site .

Note: If these downloadable PDF forms are altered in any way they will not be processed by Blue Cross and Blue Shield of Texas (BCBSTX).

Online Pharmacy Services

If your health plan includes BCBSTX prescription drug benefits, these are administered by Prime Therapeutics, our pharmacy benefits manager (PBM).

Visit Prime Therapeutics  to:

• Search for prescription drugs
• Find a pharmacy
• Mail order refills online
• View status of coverage for your drugs
• Download forms and brochures
• Get drug cost estimates

Prescription Drug Guides

• View the BCBSTX Preferred Drug Guide  (Preferred Drug List 1) or the Generics Plus Drug Guide  (Preferred Drug List 2) for employer offered plans. If you have a question about which drug list you should select, contact the customer service number on the back of your member ID card.
• View the Member Preferred Drug List  for individual plans.
• View the Specialty Pharmacy Program Drug List  which includes a reminder about coverage for self-administered specialty medications.

Prescription Drug Forms

• Prescription Drug Claim Form (for Group Plan members) 
  BCBSTX members with pharmacy benefits through an employer group insurance plan can use this form to request reimbursement for a prescription drug purchase. Members must submit the original pharmacy receipt with the completed form to Prime Therapeutics, the BCBSTX pharmacy benefits manager.
• Prescription Drug Claim Form (for Individual Plan members) 
  BCBSTX members with pharmacy benefits through an individual insurance plan can use this form to request reimbursement for a prescription drug purchase. Members must submit the original pharmacy receipt with the completed form to Prime Therapeutics, the BCBSTX pharmacy benefits manager.
• PrimeMail New Prescription Order Form  
  Members with BCBSTX prescription drug coverage can use this form to mail order new prescription maintenance medication. Mail the completed form to PrimeMail, and include the original prescription signed by your doctor.
• PrimeMail Refill Prescription Order Form 
  Members with BCBSTX prescription drug coverage can use this form to mail order refills for prescribed maintenance medication.