Prescription Drug Program Subscriber Claim Form 2026

1. Click ‘Get Form’ to open the Prescription Drug Program Subscriber Claim Form in our editor.
2. Begin by filling out the Subscriber and Patient Information sections completely. Ensure you include the ID Number from the subscriber’s Blue Cross and Blue Shield of Florida ID card.
3. Next, provide the Pharmacy Information. Enter the Pharmacy NABP number, which can be found on your pharmacy receipt or obtained directly from the pharmacy.
4. In the Prescription Information section, include all required details such as prescription receipts, quantity, and balance due if applicable. Remember that cash register receipts are not acceptable.
5. Finally, complete Section V by signing the Subscriber Certification to validate your claim. This signature is essential for processing.

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