Language Assistance Available [pdf, 561 KB] Prescription Claim Form [pdf, 823 KB] Prior Authorization Form for Prescription Drugs [pdf, 127 KB]
2016 Standard Formulary [pdf, 1393 KB] 2016 Maintenance Drug List [pdf, 751 KB] 2016 Standard with Step Therapy Formulary (Formerly known as Value Formulary) [pdf, 1483 KB] 2017 Standard Formulary [pdf, 1393 KB] 2017 Standard with Step Therapy Formulary [pdf, 1484 KB] 2017 Standard with Step Drug List [pdf, 1083 KB] Prior Authorization List [pdf, 611 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. Copyright © 2002-2017 BlueAdvantage Administrators of Arkansas