Prescription Claim Form [pdf, 882 KB] Prior Authorization Form for Prescription Drugs [pdf, 124 KB]
2015 Standard Formulary [pdf, 756 KB] Maintenance Drugs [pdf, 268 KB] Medications considered to be necessary for long periods of time.2015 Value Formulary [pdf, 746 KB] Prior Authorization List [pdf, 45 KB] Medications that require prior approval. For authorization, call 1-877-433-2973.2015 Metallic Drug List [pdf, 231 KB] 2015 Comprehensive Specialty List [pdf, 390 KB]
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Shield Association and is licensed to offer health plans in all 75 counties in Arkansas.
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