Blue Shield of California prescription drug reimbursement form

Use the appropriate Direct Member Reimbursement (DMR) form below to submit a claim to be reimbursed for a prescription you paid out of pocket for at a non-participating pharmacy. For more information visit the Drug benefits and claims FAQs.

DMR form for Medicare members (PDF, 404KB)

DMR form for non-Medicare members (PDF, 392KB)


CVS Caremark mail service pharmacy order form

To get your maintenance medication through CVS Caremark, you must first register using the appropriate mail service pharmacy order form (below). You can also register online at caremark.com. For more information visit the mail service pharmacy page

Download Medicare mail service order form (PDF, 154KB)

Download non-Medicare mail service order form (PDF, 511KB)