Prescription Claim Form [pdf, 882 KB] Prior Authorization Form for Prescription Drugs [pdf, 127 KB]
2015 Standard Formulary [pdf, 1357 KB] 2015 Essential Formulary [pdf, 988 KB] 2015 Metallic Drug List [pdf, 231 KB] 2015 Value Formulary [pdf, 1335 KB] 2015 Value Plus Formulary [pdf, 1365 KB] 2016 Essential Formulary [pdf, 1085 KB] 2016 Standard Formulary [pdf, 1128 KB] 2016 Value Formulary [pdf, 1297 KB] Maintenance Drugs [pdf, 194 KB] Medications considered to be necessary for long periods of time.Prior Authorization List [pdf, 61 KB] Medications that require prior approval. For authorization, call 1-877-433-2973.
2016 Standard/Value Formulary Non-Covered Medications with Covered Alternatives [pdf, 348 KB]
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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