Need Help? Call 855-601-9465 or TTY 800-955-8770

Prescription Drug Documents and Forms

Looking for a prescription drug plan document or a certain form? Use thie links below to browse by plan type. Note that these links are on a third-party website.

Browse Forms by Plan Type: 2018

Browse Forms by Plan Type: 2019

If you would like a friend, relative, your doctor or other provider, or other person to be your representative to ask for a coverage decision or make an appeal, please call Member Services. 

Florida Blue/Florida Blue HMO members call 1-800-926-6565, TTY number 1-800-955-8770. We are open from 8 a.m. - 8 p.m. local time, seven days a week from October 1 - February 14, and closed Federal Holidays except for Thanksgiving and Christmas. From February 15 - September 30, we are open Monday - Friday 8 a.m. - 8 p.m. local time, except for Federal holidays. 

Florida Blue Preferred HMO members, please call 1-844-783-5189, TTY number 1-800-955-8770. We are open from 8 a.m. - 8 p.m. local time, seven days a week.

Ask for the “Appointment of Representative” form. (The form is also available on Medicare’s website via the link below). The form gives that person permission to act on your behalf. It must be signed by you and by the person who you would like to act on your behalf. You must send us a copy of the signed form. Instructions on where to send the form are included in the form.

Other Miscellaneous Drug Documents:

Florida Blue is a PPO, RPPO and Rx (PDP) Plan with a Medicare contract. Florida Blue HMO and Florida Blue Preferred HMO are HMO Plans with a Medicare contract. Enrollment in Florida Blue, Florida Blue HMO or Florida Blue Preferred HMO depends on contract renewal.

For assistance, current BlueMedicare Classic (HMO), BlueMedicare Classic Plus (HMO), BlueMedicare Premier (HMO), BlueMedicare Complete (HMO SNP), BlueMedicare Select (PPO), BlueMedicare Choice (Regional PPO), BlueMedicare Value (PPO) , BlueMedicare Value Rx (PDP), BlueMedicare Premier Rx (PDP) and BlueMedicare Complete Rx (PDP) members should call our Member Services number at 1-800-926-6565 (TTY: 1-800-955-8770). Florida Blue Medicare member, please call 1-855-601-9465 (TTY: 1-800-955-8770). Hours are 8 a.m. - 8 p.m. local time, seven days a week from October 1 to March 31, except for Thanksgiving and Christmas. From April 1 to September 30, we are open Monday - Friday, 8 a.m. - 8 p.m. local time.

For assistance, current BlueMedicare Preferred (HMO), BlueMedicare Preferred HMO (HMO SNP) and BlueMedicare Preferred POS (HMO POS) Member Services number at 1-844-783-5189 for additional information. (TTY users should call 1-800-955-8770.) Hours are 8:00 a.m. - 8:00 p.m. local time, seven days a week.
Florida Blue Medicare Supplement Insurance policies are not connected with or endorsed by the U.S. Government or the Federal Medicare Program.These policies have limitations and exclusions.

Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc., an Independent Licensee of the Blue Cross and Blue Shield Association.

FBM FRM 001  062018

 

Last Updated: 10.01.2018

Y0011_34455 1018 CMS Accepted

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Need Help? Call 855-601-9465 or TTY 800-955-8770 | Monday - Friday - 8am - 8pm

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Generally, the pronouns "our," "we" and "us" used throughout this website are intended to refer collectively to Blue Cross and Blue Shield of Florida, Inc. and its subsidiaries and affiliates. However, where appropriate, the content may identify a particular company; there, any pronouns refer to that specific entity.

Health insurance is offered by Blue Cross and Blue Shield of Florida, Inc., DBA Florida Blue. HMO coverage is offered by Health Options Inc., DBA Florida Blue HMO, an HMO affiliate of Blue Cross and Blue Shield of Florida, Inc. Dental, Life and Disability are offered by Florida Combined Life Insurance Company, Inc., DBA Florida Combined Life, an affiliate of Blue Cross and Blue Shield of Florida, Inc. These companies are Independent Licensees of the Blue Cross and Blue Shield Association.

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