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Healthmine breach affects some Health Advantage members. Learn more.

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Members

Pharmacy information

Arkansas Public School and State Employees use another vendor for their pharmacy benefits administrator. For your benefits information, go to arbenefits.org.

Mail-order drugs

For those members with mail-order drug benefit, an online service is available, which allows you to:

For more information, visit pharmacy site on Blueprint Portal. Or download and complete the paper form. [pdf]

Pharmacy forms

  • Prescription Claim Form [pdf]
  • Prior Approval 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.

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