Prescription Drug Forms

The following prescription drug forms are available as PDF files. Just click on a form to download it. Have your doctor fax in completed forms at 1-877-243-6930. Your doctor can submit online or call 1-855-457-0407. You may need to install a PDF reader program to view these files. One option is Adobe Reader; this can be downloaded free of charge at Adobe's site.

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Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

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