Prescription Claim Form [pdf, 882 KB] Prior Authorization Form for Prescription Drugs [pdf, 127 KB]
2016 Standard Formulary [pdf, 1152 KB] 2016 Maintenance Drug List [pdf, 313 KB] 2016 Standard with Step Therapy Formulary (Formerly known as Value Formulary) [pdf, 1149 KB] Prior Authorization List [pdf, 49 KB] Medications that require prior approval. For authorization, call 1-877-433-2973.2016 Standard/ Standard with Step Therapy Formulary Non-Covered Medications with Covered Alternatives [pdf, 348 KB]
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Shield Association and is licensed to offer health plans in all 75 counties of Arkansas.
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