Prior Approval Form for Prescription Drugs[pdf] This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign and date. Fax signed forms to CVS/Caremark at 1-855-245-2134 for prior approval and quantity limit requests. Contact CVS/Caremark at 1-855-582-2022 with questions regarding the prior approval and quantity limit review process.
For Step Therapy and Non-Formulary Exception requests, fax the form to 501-378-6980. For Step Therapy and Non-Formulary Exception request questions, contact 501-378-3392.
Pharmacy claim search in My Blueprint Your prescription claims history, including prescription number, date
filled, prescriber, quantity, pharmacy, amount paid by you and amount paid
by your pharmacy plan. To access information about your personal pharmacy
claims, you must register to use My Blueprint, our member self-service
If you choose to access other websites from this website, you agree, as a condition of choosing any such
link or access, that Arkansas Blue Cross and Blue Shield (ABCBS) is not and shall not be responsible or liable to you or to
others in any way for your decision to link to such other websites. You further agree that ABCBS and its
affiliates, its directors, officers, employees and agents ("the ABCBS Parties") are not responsible for
the content of any other website to which you may link, nor are ABCBS or the ABCBS Parties liable or responsible
under any circumstances for the activities, omissions or conduct of any owner or operator of any other
website. Once you choose to link to another website, you understand and agree that you have exited this
website and are no longer accessing or using any ABCBS Data. You understand and agree that by making any
third-party website link available as an option to you, ABCBS does not in any way endorse any such website,
nor state or imply that you should access such website or any services, products or information which
may be offered to you through such other websites or by the owner or operator of such other websites.
The owners or operators of any other websites (not ABCBS) are solely responsible for the content and operation
of all such websites. ABCBS makes no warranties or representations of any kind, express or implied, nor
of merchantability or fitness for a particular purpose, nor of non-infringement, with regard to the content
or operation of any other website to which you may link from this website.