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Medicare Forms
Prescription Drug (Part D)

View and download important forms and documents about your BlueMedicare plan from Florida Blue.

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Call Member Services at 1-800-926-6565 (TTY 1-800-955-8770)

Hours: 8 a.m. to 8 p.m. local time, seven days a week, from October 1 through March 31, except for Thanksgiving and Christmas. From April 1 through September 30, our hours are 8 a.m. to 8 p.m. local time, Monday through Friday, except for major holidays.

More topics:

2026 BlueMedicare Premier Rx

S5904 001 Florida Statewide

Annual Notice of Changes -- Florida - last updated 8/26/25

Evidence of Coverage -- Florida - last updated 9/4/25

Summary of Benefits -- Statewide - last updated 8/22/25

Enrollment Form -- Statewide - last updated 8/13/25

Formulary -- Statewide - last updated 10/7/25

Medicare Star Rating -- Statewide - last updated 10/16/24

Low Income Subsidy (LIS) - Extra Help Program - last updated 8/29/25

Prescription Drug Transition Policy - last updated xx/xx/xx

2025 BlueMedicare Premier Rx

• S5904-001 - BlueMedicare Premier Rx (PDP) - Florida Statewide

• 2025 Annual Notice of Changes - BlueMedicare Premier Rx - last updated 8/23/24

• 2025 Evidence of Coverage - BlueMedicare Premier Rx - last updated 5/28/25

• 2025 Summary of Benefits - BlueMedicare Premier Rx - Statewide (Florida) - last updated 8/22/24

• 2025 Enrollment Form - BlueMedicare Premier Rx - Statewide (Florida) - last updated 4/30/25

• 2025 Medicare Star Rating - BlueMedicare Premier Rx - Statewide (Florida) - last updated 10/16/24

• 2025 Formulary - BlueMedicare Premier Rx - Statewide (Florida) - last updated 9/19/25

• 2025 Low Income Subsidy (LIS) - Extra Help Program - last updated 10/1/24

• 2025 Prescription Drug Transition Policy - last updated 5/28/25

FBM FORM NF

Last Updated: 10.01.2025
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