Prescription Drug Forms

Mail Order Information/Forms

Blue Cross of Idaho members have TWO mail order options!  Select the link for additional information.

(Formerly Precision Rx)

WellPoint NextRx Forms P.O. Box 746000 Cincinnati, OH 45274-6000 1-800-962-8192   TTY/TDD 800-221-6915

Walgreens Mail Service P.O. Box 29061 Phoenix, AZ  85038-9061 1-800-304-6710

PLEASE NOTE: Not all Blue Cross of Idaho policies include mail order pharmacy benefits.  Please check your policy, if you are unsure, or contact Customer Service at 1 (800) 627-1188.

Prescription Drug Reimbursement Form

When a member with a defined pharmacy benefit (i.e., copay plan) pays the full cost for medications at the pharmacy without using their benefit, they may use this form to request reimbursement.  This does not apply to members who have a major medical pharmacy benefit (i.e., members on HSA Blue products).    

Link to form