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.

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 2010 BCBSTX Preferred Drug Guide  for employer offered plans.
• View the Member Preferred Drug List  for individual plans.
• See a list of specialty prescription drugs  on our preferred list.
• See a list of the most commonly prescribed BCBSTX preferred drugs 
• View dispensing limitations on BCBSTX preferred drugs 

Prescription Drug Forms

• Prescription Reimbursement Claim Form 
  Members with pharmacy benefits through Blue Cross and Blue Shield of Texas can use this form to file pharmacy claims for reimbursement.
• Mail Order Prescription Form 
  Members with pharmacy mail order benefits through Blue Cross and Blue Shield of Texas can use this form to order prescription medication by mail.
• Quantity Limit Override Request Form 
  The Quantity Override Request Form should be completed by the prescribing physician and submitted to Pharmacy Programs when requesting an override for their patient. If they do not have this form available, we ask that they fax or e-mail the information that is requested on this form.