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, Health Advantage Coverage Policy, the medical pharmacy prior authorization list, or the member’s benefit certificate to determine which therapies need prior authorization.

• For Arkansas Blue Cross and Blue Shield members, please see Arkansas Blue Cross medical pharmacy
• For Octave members, please see Octave medical pharmacy.
• For Blue Advantage members, please see Blue Advantage medical pharmacy.
  • Example: Walmart
• Arkansas State Employees, Arkansas Public School Employees, and Arkansas State Police utilize EBRx for medical pharmacy prior authorizations management. For a complete list of medications that require prior approval through EBRx, please review on Availity or call the customer sercice number on the back of the ID card.
• Certain Health Advantage plans require prior approval of medical oncology medication through Carelon Medical Oncology. Please contact customer service at the number on the back of the ID card for verification.
• 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.