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PHARMACY RESOURCES

Prescription Drugs

For Members with Medicare coverage:

Please refer to your Medicare plan for more information on Prescription Drugs or call your FCC case manager if you have questions. Your Florida Community Care Case Manager can be reached at 1-833-FCC-PLAN or 711 for TDD/TTY.

For Members without Medicare coverage:

Getting My Medicine

Generic drugs must be used when available. There are drugs that may have a limit on how much you can get at one time and its strength. Sometimes you have to try other medications first before we approve a drug. This is called Step-Therapy.

Your doctor knows about:

The drugs on the Preferred Drug List

The drugs that need prior approval

How to process special requests 

Pharmacy Documents

Preferred Drug List (PDF)

Diabetic Testing Supply Formulary List (PDF)

Managed Medical Assistance (MMA) Preferred Drug List for members without Medicare coverage

If you are a member with no Medicare coverage, please click here for the Prescription Drug List for the Medicaid Managed Medical Assistance (MMA) Program.

Your doctor will get prior approval for the drugs that need it. Your doctor may want to give you a drug that is not on the PDL. Your doctor will ask an approval through Florida Community Care’s Pharmacy Department. We will reply to your doctor in (24) hours. If it is the weekend, we will reply the next working day. If the request is approved, we will tell your doctor. If a request is denied, a letter will be mailed. The letter will tell you the reason for the denial. The letter will let you know how to appeal.

You may be taking a drug that is no longer on our PDL. Your doctor can ask us to keep paying for this drug by requesting a prior approval. The drug must be safe and help you with your medical problem.

There are drugs that are not covered, for example some drugs for weight loss or cosmetic purposes. You may want to know the list of drugs that are covered. Call Enrollee Services at 1-833-FCC-PLAN or 711 for TDD/TTY.

You may call Enrollee Services to get the following:

  • A copy of the Preferred Drug List
  • Information about drugs
  • Find out if a drug is covered
  • Find out how to appeal a decision

Your doctor will work with Florida Community Care to decide which drugs are best for you.

Pharmacies

Florida Community Care has contracts with certain pharmacies. You must get your drugs at one of these pharmacies. Click Here to Find A Pharmacy closest to you. 

Mail Service Pharmacy

Florida Community Care wants to offer a time-saving way to get your medicine. You can get a thirty (30) day supply. This is a great benefit. It is easy and can save you time. You don’t have to go to the pharmacy every month. If you want more info, call the Enrollee Services Department. They can help you sign up. 

Getting an exception to the Preferred Drug List (PDL)

Drugs not listed on the Preferred Drug List (PDL) are called non‐preferred drugs. For non‐preferred drugs, you have the following options:

  • You can ask your physician to order a similar drug that is listed on the Preferred Drug List (PDL).
  • You can ask your physician to request an exception so your non‐preferred drug can be covered by your benefit.
  • You can start the request for exception for a non‐preferred drug.
  • If you want to start the exception process, you can call Enrollee Services or your case manager at 1-833-FCC-PLAN or 711 for TDD/TTY

Over-the-Counter Benefit (OTC)

Florida Community Care offers a $25.00 over-the-counter (OTC) benefit every month per family. You can present your FCC ID card and the Over-the-Counter benefit list at an FCC contracted pharmacy. Please note that a generic product will be given, if on hand. To get more info, call our Enrollee Services Department at 1-833-FCC-PLAN or 711 for TDD/TTY. 

Specialty Pharmacy Information:

FCC covers a full range of specialty prescription medications. We have a list of drugs that we cover. This list is called the AHCA PDL. You can find this list here. You may also call Enrollee Services. 1-833-FCC-PLAN or 711 for TDD/TTY.

We cover brand name and generic drugs. Generic drugs have the same ingredients as brand name drugs, but they are often cheaper than brand name drugs. They work the same. Sometimes, we may need to approve using a brand name drug before your prescription is filled. You can fill your first prescription at any network pharmacy that is in our provider network. The pharmacy will arrange to have refills delivered to your place of residence or a CVS pharmacy that you specify. Make sure to bring your Plan ID card with you to the pharmacy.

The list of covered drugs may change from time to time, but we will let you know if anything changes

Smoking Cessation Information:

Smoking Cessation Products are included in the AHCA PDL. These products can be obtained with a prescription from your Doctor. The smoking cessation products filled on a prescription will not count against your OTC benefit. No prior authorization is required. You may also call Enrollee Services at 1-833-FCC-PLAN or 711 for TDD/TTY.

HIV Drugs Information:

HIV drugs are included in the AHCA PDL. These products can be obtained with a prescription from your Doctor. You can find this list on the State Web site. Prior authorization may be required. Your Doctor can request this. You may also call Enrollee Services at 1-833-FCC-PLAN or 711 for TDD/TTY. 

Contraceptive Drugs Information:

Contraceptive drugs are included in the AHCA PDL. These products can be obtained with a prescription from your Doctor. No prior authorization is required. You may also call Enrollee Services at 1-833-FCC-PLAN or 711 for TDD/TTY.

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