Prescription Claim Form [pdf, 882 KB] Prescription Mail Service Order Form [pdf, 1155 KB] If your policy has a mail-order drug benefit, use this form to order new and/or refill mail service prescriptions.Prior Authorization Form for Prescription Drugs [pdf, 125 KB]
2015 Standard Formulary [pdf, 1385 KB] 2015 Value Formulary [pdf, 1218 KB] 2015 Metallic Drug List [pdf, 231 KB] 2015 Metallic Comprehensive Drug List [pdf, 3382 KB] Maintenance Drugs [pdf, 268 KB] Medications considered to be necessary for long periods of time.2015 Comprehensive Specialty List [pdf, 390 KB] 2015 Essential Formulary [pdf, 488 KB] Prior Authorization List [pdf, 59 KB] Medications that require prior approval. For authorization, call 1-877-433-2973.
Arkansas Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross
and Blue Shield Association and is licensed to offer health plans in all 75 counties
of Arkansas. Copyright © 2001-2015 Arkansas Blue Cross and Blue Shield