Blue Cross Blue Shield of Minnesota
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About Prescription Drugs
Forms
Prior authorization and formulary exception form (PDF)
This form is also called the “Minnesota Uniform Form for Prescription Drug Prior Authorization Requests & Formulary Exceptions.” Your doctor must complete and submit this form. Your doctor can also get this form by calling provider services at (651) 662-5200 or 1-800-262-0820.
Prescription drug claim form (PDF)
Complete and submit this form to request reimbursement for a prescription.
Quantity limits override request form (PDF)
Your doctor must complete and submit this form. Your doctor can also get this form by calling provider services at (651) 662-5200 or 1-800-262-0820.
Specialty medication prescription form (PDF)
Complete this form and send it to the appropriate specialty network vendor.
Step Therapy authorization form (PDF)
Your doctor must complete and submit this form. Your doctor can also get this form by calling provider services at (651) 662-5200 or 1-800-262-0820.
