MSHO Directories & Formulary

SecureBlue MSHO

Visit our public BCBS of MN SecureBlue℠ (Minnesota Senior Health Options) page to access:

• Plan documents including Summary of Benefits, Member Handbook, Annual Notice of Changes, and much more!
• Click here for direct access to the SecureBlue MSHO Provider and Pharmacy Directory (PDF).
• Click here for direct access to the SecureBlue MSHO Formulary in PDF (PDF).
  • Or visit myprime.com for online tools including pharmacy documents.

Medicare Part D Claim Reimbursement Form (PDF)

• Form for members/Care Coordinators to request reimbursement for:
  • Part D covered vaccines received in a clinic setting or
  • Self-administered medications while in a hospital during an observation stay or in the Emergency Room
• Clinics/hospitals cannot bill certain Part D covered drugs. Members will get billed and can 1) pay the bill and submit for reimbursement or 2) not pay the bill and submit invoice for reimbursement. Ask your PR Consultant if you have any questions.
• Form can be mailed to address on the form or faxed to 1-800-693-6703.
• Must include copy of paid receipt or unpaid invoice.