Members
Pharmacy information
Pharmacy forms
- Prescription Claim Form [pdf]
- Prescription Mail Service Order Form[pdf]
If your policy has a mail-order drug benefit, use this form to order new and/or refill mail service prescriptions. - Prior Authorization Form for Prescription Drugs [pdf]
Information contained in this form is Protected Health Information under HIPAA Complete/review information, sign and date. Fax signed forms to CVS/Caremark at 855-245-2134 for prior authorization, step therapy, and quantity limit requests. Contact CVS/Caremark at 855-582-2022 with questions regarding the step therapy, prior authorization and quantity limit review process. For Non-Formulary Exception requests, fax the form to 501-378-6980. For Non-Formulary Exception request questions, contact 501-378-3392.
ARHOME drug lists
Understanding your pharmacy coverage
- Using your pharmacy benefits
How to use your benefits and the advantages your pharmacy plan offers you. - View pharmacy claims in Blueprint Portal
Your prescription claims history, including prescription number, date filled, prescriber, quantity, pharmacy, amount paid by you and amount paid by your pharmacy plan. To access information about your personal pharmacy claims, you must register to use Blueprint Portal, our member self-service center. - Network pharmacy search
- Drug pricing
- Save money on medications
- How to read labels
- Generic medications
- Specialty drugs
- Free immunizations at pharmacy
Mail-order drugs
For those members with the mail-order drug benefit, an online service is available, which allows you to:
- Refill your mail-order prescriptions;
- Check the status of your mail order;
- Review your mail-order prescription history.
- Mail-order drug list / Maintenance medications [pdf]
For more information, navigate to the pharmacy site on Blueprint Portal. Or download and complete the paper form. [pdf]