Prescription Drug Claim Form
To find this form, members must visit the Express Scripts website after login to their health plan site. Click the link in the Refill a Prescription section after login. On the Express Scripts website, select the Claims Reimbursement Form from the Printable Forms section.
If your doctor will no longer be in the BCBSGA network, you may have the option to continue to receive care for a limited time. Care should be related to treatment already begun for this spell of illness/problem or if you are pregnant and began prenatal care. Complete this form and provide to your doctor who will fill out and return to BCBSGA. You will receive a decision in the mail about continuing care with that doctor.
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