Contact us at 1-833-FCC-PLAN | Contact Us

Pharmacy Benefits

Florida Community Care uses the Agency for Health Care Administration (AHCA) Preferred Drug List (PDL). To determine which drugs have limitations or require prior authorization, please review the PDL, Summary of Drug Limitations, and Drug Criteria pages.  Use the links below to find more information.

If a medication is not covered or has a restriction such as a prior authorization, step therapy, age limitation, or quantity limit that needs additional review, please complete the appropriate PA request form on the AHCA website or by following this link.

ALL fields must be completed before faxing.

Please fax the completed form to CVS CAREMARK at 1-866-255-7569.

For more information on pharmacy benefits available to Florida Community Care members, click here.

1
📁 Home → 📁 DC_Forms_1 ↓
NameSizeDate
Abecma_Criteria_a11y.pdf

Open Download Copy Link 313.22 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
313.22 KBOctober 28, 2022
Abecma_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 232.03 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
232.03 KBOctober 28, 2022
Abilify_Mycite_Criteria_a11y.pdf

Open Download Copy Link 353.14 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
353.14 KBOctober 28, 2022
Abilify_Mycite_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 240.06 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
240.06 KBOctober 28, 2022
Abstral-Actiq-Fentora-Lazanda-Onsolis-Subsys_Form_a11y.pdf

Open Download Copy Link 1.97 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
1.97 MBOctober 28, 2022
Abstral-Actiq-Fentora-Lazanda-Onsolis-Subsys_Form_a11y_PAC_UA_Report.pdf

Open Download Copy Link 293.71 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
293.71 KBOctober 28, 2022
Adakveo_Criteria_a11y.pdf

Open Download Copy Link 301.34 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
301.34 KBOctober 28, 2022
Adakveo_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 240.48 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
240.48 KBOctober 28, 2022
Aduhelm_Criteria_a11y.pdf

Open Download Copy Link 371.49 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
371.49 KBOctober 28, 2022
Aduhelm_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 269.64 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
269.64 KBOctober 28, 2022
https://fcchealthplan.com/pharmacy-resources/?eeFolder=DC_Forms_1&ee=1&eeListID=1 0 4

Page: 1 of 5

10

020cd9a581

QUICK LINKS

Find Providers
Pharmacy Resources
Health & Wellness
Member Resources
Member News
Helpful Links
Contact Us
FCC Member Services
1-833-FCC-PLAN
Translate »