Language Assistance Available [pdf, 561 KB] 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]
2016 Standard Formulary [pdf, 1480 KB] 2017 Metallic Formulary [pdf, 3876 KB] 2016 Maintenance Drug List [pdf, 751 KB] 2016 Metallic Formulary [pdf, 3938 KB] 2016 Standard with Step Therapy Formulary (Formerly known as Value Formulary) [pdf, 1483 KB] Prior Authorization List [pdf, 611 KB] Medications that require prior approval. For authorization, call 1-877-433-2973.
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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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