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, 756 KB] 2015 Value Formulary [pdf, 746 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, 969 KB] Prior Authorization List [pdf, 47 KB] Medications that require prior approval. For authorization, call 1-877-433-2973.
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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