Medical pharmacy

Pharmaceutical therapies administered by a provider and billed through the medical benefit. Many of these therapies require prior authorization. Please refer to Availity Essentials portal, Arkansas Blue Cross Coverage Policy, the medical pharmacy prior authorization list, or the member’s benefit certificate to determine which therapies need prior authorization.

• For Health Advantage members, please see Health Advantage medical pharmacy.
  • Example: ASE/PSE or Arkansas State Police
• For Blue Advantage members, please see Blue Advantage medical pharmacy.
  • Example: Walmart
• For Octave members, please see Octave medical pharmacy.
• For BlueMedicare members, please see Medicare Advantage.
• The Federal Employee Program (FEP) utilizes Magellan Rx Management for medical pharmacy prior authorization management
• For ARBCBS and Octave Retail Pharmacy information, please visit: Retail Pharmacy
• Medical Oncology medications require prior authorization approval through Carelon Medical Oncology
• For a list of medication requiring prior authorization please visit: Prior Authorization Medication List

To complete a prior authorization or organizational determination, please complete the Authorization/Organization Determination Request form and submit it by fax or email as indicated on the form.

To understand which products require approval please see the prior authorization medical list and the applicable coverage policy. Prior approval status is listed at the top of the policy.

Please note: Not all services require prior authorization. You may contact customer service to determine what services require prior authorization. If the service does not require prior authorization, the service may be considered cosmetic, investigational, or may not be a covered benefit. We recommend you submit an Organizational Determination/Benefit Inquiry form. Failure to obtain any necessary authorizations may result in denial or reduction in benefits.