Prescription Drug Claim Form - Bcbstx.com 2025

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Call us toll-free at 1-888-657-6061 (TTY: 711).
Form CMS-1696 can be downloaded at .cms.gov or obtained by calling the Customer Service number on your member ID card. The claim may be submitted via mail or fax to the address or phone number on the Medicare Part D Prescription Drug Claim Form.
Blue Cross and Blue Shield of Texas utilizes Prime Therapeutics LLC as our pharmacy benefit manager to administer certain core services in our pharmacy program that will help contain rising drug costs and maintain and improve the quality of care delivered to members.
To send a prescription order through the mail, visit bcbstx.com and log in to Blue Access for MembersSM. Complete the mail order form. Mail your prescription, completed order form and payment to Express Scripts Pharmacy. Ask your doctor for a prescription for up to a 90-day supply of each of your long-term medicines.
What is a pharmacy benefit manager? In its statute governing third party administrators, Texas Insurance Code Section 4151.151 defines pharmacy benefit manager as a person, other than a pharmacy or pharmacist, who acts as an administrator in connection with pharmacy benefits.
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Provider Services Hotline If your provider needs to contact us, they may call 1-877-784-6802.
Prescription Claim means any electronic or paper request for payment or reimbursement arising from retail participating pharmacies, mail-order pharmacies, and specialty pharmacies, Sample 1.
Prime Therapeutics is the PBM that provides drug benefits through BCBSTX.

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