Language Assistance Available [pdf, 561 KB] Prescription Claim Form [pdf, 823 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 Approval Form for Prescription Drugs [pdf, 50 KB]
2018 Metallic Formulary [pdf, 3907 KB] 2018 Standard with Step Drug List [pdf, 1188 KB] 2018 Standard with Step Therapy Formulary [pdf, 1566 KB] Prior Approval List [pdf, 149 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.
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