Prescription Claim Form (PDF) Prior Authorization Form for Prescription Drugs (PDF)
2014 Standard Formulary (PDF) 2014 Standard Formulary Preferred Drug List (PDF) Maintenance Drugs (PDF) Medications considered to be necessary for long periods of time.2014 Value Formulary (PDF) Prior Authorization List (PDF) Medications that require prior approval. For authorization, call 1-877-433-2973.
2014 Value Formulary Preferred Drug List (PDF) 2014 Formulary Two (formerly called Complete Care) (PDF)
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Shield Association and is licensed to offer health plans in all 75 counties of Arkansas.
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