Forms

Provider Pharmacy Forms

Visit www.myrxsassitant.com for provider pharmacy forms, including Medicare Part D and Coverage Determination/Redeterminations/Appeals. From the main page, select "Forms and Brochures" which is located at the bottom of the page, then select your plan information.

BlueMedicare PFFS has a Medicare Advantage contract approved by the Centers for Medicare & Medicaid Services. Contracts are renewed annually and availability of coverage beyond the end of the current contract year is not guaranteed. A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. A doctor or hospital must agree to accept the plan's terms and conditions prior to providing health care services to a member, with the exception of emergencies. If a doctor or hospital does not agree to accept our payment terms and conditions, they may not provide health care services to the member, except in emergencies.