How do I submit a claim for a prescription filled at a non-network pharmacy?

If you paid out-of-pocket for a covered prescription drug, please complete the Prescription Reimbursement Claim Form and mail it to the appropriate address listed on the form.

We will pay our share of the cost based on the drug payment stage you are in. Be sure to include all required information as referenced in Step 2.

Last updated: 09/17/2013

H4152_2015web88 Approved

Blue Cross & Blue Shield of Rhode Island is an HMO plan with a Medicare contract. Enrollment in Blue Cross & Blue Shield of Rhode Island depends on contract renewal.