Pharmacy Forms

 Prescription Drug Claim Form - Prime Therapeutics

Use this claim form for prescriptions filled by Prime Therapeutics. Prime Therapeutics LLC is an independent company providing pharmacy benefit management services for Horizon BCBSNJ members. ID: 3272

 Prescription Drug Mail Order Form (Spanish) - Prime Therapeutics

Use este formulario para pedido de medicamento recetado por correo. ID: 3208S

 Prescription Drug Mail Order Form - Prime Therapeutics

Use this form to order new or refill prescriptions delivered by mail from Prime Therapeutics. ID: 3208