Contact us at 1-833-FCC-PLAN | Contact Us
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.
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Abecma_Criteria_a11y.pdf
application/pdfAbecma_Criteria_a11y.pdf Open Download Copy Link 313.22 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Abecma_Criteria_a11y_PAC_UA_Report.pdf
application/pdfAbecma_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 |
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Abilify_Mycite_Criteria_a11y.pdf
application/pdfAbilify_Mycite_Criteria_a11y.pdf Open Download Copy Link 353.14 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Abilify_Mycite_Criteria_a11y_PAC_UA_Report.pdf
application/pdfAbilify_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 |
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Abstral-Actiq-Fentora-Lazanda-Onsolis-Subsys_Form_a11y.pdf
application/pdfAbstral-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 |
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Abstral-Actiq-Fentora-Lazanda-Onsolis-Subsys_Form_a11y_PAC_UA_Report.pdf
application/pdfAbstral-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 |
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Adakveo_Criteria_a11y.pdf
application/pdfAdakveo_Criteria_a11y.pdf Open Download Copy Link 301.34 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Adakveo_Criteria_a11y_PAC_UA_Report.pdf
application/pdfAdakveo_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 |
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Aduhelm_Criteria_a11y.pdf
application/pdfAduhelm_Criteria_a11y.pdf Open Download Copy Link 371.49 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Aduhelm_Criteria_a11y_PAC_UA_Report.pdf
application/pdfAduhelm_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 |
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Adult_High_Dose_Antipsychotic_Criteria_a11y.pdf
application/pdfAdult_High_Dose_Antipsychotic_Criteria_a11y.pdf Open Download Copy Link 331.24 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Adult_High_Dose_Antipsychotic_Criteria_a11y_PAC_UA_Report.pdf
application/pdfAdult_High_Dose_Antipsychotic_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 270.34 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Adult_High_Dose_Antipsychotic_Form_a11y.pdf
application/pdfAdult_High_Dose_Antipsychotic_Form_a11y.pdf Open Download Copy Link 1.37 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Adult_High_Dose_Antipsychotic_Form_a11y_PAC_UA_Report.pdf
application/pdfAdult_High_Dose_Antipsychotic_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 285.31 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Afrezza_Criteria_a11y.pdf
application/pdfAfrezza_Criteria_a11y.pdf Open Download Copy Link 337.48 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Afrezza_Criteria_a11y_PAC_UA_Report.pdf
application/pdfAfrezza_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 265.73 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Ajovy_Criteria_a11y.pdf
application/pdfAjovy_Criteria_a11y.pdf Open Download Copy Link 314.36 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Ajovy_Criteria_a11y_PAC_UA_Report.pdf
application/pdfAjovy_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 229.82 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Albumin_Form_a11y.pdf
application/pdfAlbumin_Form_a11y.pdf Open Download Copy Link 1.95 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Albumin_Form_a11y_PAC_UA_Report.pdf
application/pdfAlbumin_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 286.56 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Aldurazyme_Criteria_a11y.pdf
application/pdfAldurazyme_Criteria_a11y.pdf Open Download Copy Link 299.23 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Aldurazyme_Criteria_a11y_PAC_UA_Report.pdf
application/pdfAldurazyme_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 233.7 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Alinia_Criteria_a11y.pdf
application/pdfAlinia_Criteria_a11y.pdf Open Download Copy Link 334 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Alinia_Criteria_a11y_PAC_UA_Report.pdf
application/pdfAlinia_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 231.21 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Amifampridine_Criteria_a11y.pdf
application/pdfAmifampridine_Criteria_a11y.pdf Open Download Copy Link 313.13 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Amifampridine_Criteria_a11y_PAC_UA_Report.pdf
application/pdfAmifampridine_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 260.05 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Amondys_Criteria_a11y.pdf
application/pdfAmondys_Criteria_a11y.pdf Open Download Copy Link 344.51 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Amondys_Criteria_a11y_PAC_UA_Report.pdf
application/pdfAmondys_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 262.99 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Anti-Parkinsons_Criteria_a11y.pdf
application/pdfAnti-Parkinsons_Criteria_a11y.pdf Open Download Copy Link 300.69 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Anti-Parkinsons_Criteria_a11y_PAC_UA_Report.pdf
application/pdfAnti-Parkinsons_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 243.59 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Antidepressants_Under_6_Years_Form_a11y.pdf
application/pdfAntidepressants_Under_6_Years_Form_a11y.pdf Open Download Copy Link 1.74 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Antidepressants_Under_6_Years_Form_a11y_PAC_UA_Report.pdf
application/pdfAntidepressants_Under_6_Years_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 284.69 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Antipsychotic_6Years_Form_a11y.pdf
application/pdfAntipsychotic_6Years_Form_a11y.pdf Open Download Copy Link 2.3 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Antipsychotic_6Years_Form_a11y_PAC_UA_Report.pdf
application/pdfAntipsychotic_6Years_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 298.95 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Antipsychotic_Polypharmacy_Criteria_a11y.pdf
application/pdfAntipsychotic_Polypharmacy_Criteria_a11y.pdf Open Download Copy Link 319.96 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Antipsychotic_Polypharmacy_Criteria_a11y_PAC_UA_Report.pdf
application/pdfAntipsychotic_Polypharmacy_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 230.54 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Antipsychotic_Under18_Form_a11y.pdf
application/pdfAntipsychotic_Under18_Form_a11y.pdf Open Download Copy Link 2.85 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Antipsychotic_Under18_Form_a11y_PAC_UA_Report.pdf
application/pdfAntipsychotic_Under18_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 284.47 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Aplenzin_Criteria_a11y.pdf
application/pdfAplenzin_Criteria_a11y.pdf Open Download Copy Link 308.7 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Aplenzin_Criteria_a11y_PAC_UA_Report.pdf
application/pdfAplenzin_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 276.91 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Arikayce_Criteria_a11y.pdf
application/pdfArikayce_Criteria_a11y.pdf Open Download Copy Link 306.31 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Arikayce_Criteria_a11y_PAC_UA_Report.pdf
application/pdfArikayce_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 229.27 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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