Prescription Claim Form [pdf, 882 KB] Prior Authorization Form for Prescription Drugs [pdf, 127 KB]
2016 Standard Formulary [pdf, 1150 KB] 2016 Maintenance Drug List [pdf, 192 KB] 2016 Standard with Step Therapy Formulary (Formerly known as Value Formulary) [pdf, 1150 KB] Prior Authorization List [pdf, 50 KB] Medications that require prior approval. For authorization, call 1-877-433-2973.
BlueAdvantage Administrators of Arkansas 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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