Updated July 27, 2023
An Arkansas Medicaid prior authorization form must be filled out and submitted to Arkansas Medicaid in order for medical offices to request State coverage for a non-preferred drug prescription. Along with this form, the medical professional should include any relevant clinical documentation that supports their justification to request coverage for a non-preferred medication. Once completed, this form should be submitted by fax to the number provided below.
Fax – 1 (800) 424-7976
Preferred Drug List – List used by the State to classify their approved prescription drugs