Prescription Drug Plan Enrollment Forms
Who is this for?
![](/content/microsites/medicare/en/index/help/forms-documents/enrollment/pdp/_jcr_content/par/whoisthisfor/image.img.png/1570642382161.png)
If you want to sign up for a Medicare Part D prescription drug plan, you can find the enrollment form here.
What you'll need:
- Your Medicare card
- Your banking information and a voided check if you want to sign up for automatic payment withdrawal
- 2023 Prescription BlueSM PDP Enrollment Form (PDF)
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