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