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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Benlysta_Criteria_a11y.pdf
application/pdfBenlysta_Criteria_a11y.pdf Open Download Copy Link 354.94 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Benlysta_Criteria_a11y_PAC_UA_Report.pdf
application/pdfBenlysta_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 251.02 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Beovu_Criteria_a11y.pdf
application/pdfBeovu_Criteria_a11y.pdf Open Download Copy Link 336 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Beovu_Criteria_a11y_PAC_UA_Report.pdf
application/pdfBeovu_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 241.91 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Besemri_Criteria_a11y.pdf
application/pdfBesemri_Criteria_a11y.pdf Open Download Copy Link 310.42 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Besemri_Criteria_a11y_PAC_UA_Report.pdf
application/pdfBesemri_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 234.08 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Bile_Salts_Agents_Criteria_a11y.pdf
application/pdfBile_Salts_Agents_Criteria_a11y.pdf Open Download Copy Link 336.02 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Bile_Salts_Agents_Criteria_a11y_PAC_UA_Report.pdf
application/pdfBile_Salts_Agents_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 256.19 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Blincyto_Criteria_a11y.pdf
application/pdfBlincyto_Criteria_a11y.pdf Open Download Copy Link 290.38 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Blincyto_Criteria_a11y_PAC_UA_Report.pdf
application/pdfBlincyto_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 233.39 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Boniva_inject_Criteria_a11y.pdf
application/pdfBoniva_inject_Criteria_a11y.pdf Open Download Copy Link 427.42 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Boniva_inject_Criteria_a11y_PAC_UA_Report.pdf
application/pdfBoniva_inject_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 269.12 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Botulinum_Criteria_a11y.pdf
application/pdfBotulinum_Criteria_a11y.pdf Open Download Copy Link 379.92 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Botulinum_Criteria_a11y_PAC_UA_Report.pdf
application/pdfBotulinum_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 244.59 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Breyanzi_Criteria_a11y.pdf
application/pdfBreyanzi_Criteria_a11y.pdf Open Download Copy Link 298.31 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Breyanzi_Criteria_a11y_PAC_UA_Report.pdf
application/pdfBreyanzi_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 242.06 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Brisdelle_Criteria_a11y.pdf
application/pdfBrisdelle_Criteria_a11y.pdf Open Download Copy Link 288.58 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Brisdelle_Criteria_a11y_PAC_UA_Report.pdf
application/pdfBrisdelle_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 231.17 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Bronchitol_Criteria_a11y.pdf
application/pdfBronchitol_Criteria_a11y.pdf Open Download Copy Link 287.44 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Bronchitol_Criteria_a11y_PAC_UA_Report.pdf
application/pdfBronchitol_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 228.22 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Buprenorphine_Agents_Criteria_a11y.pdf
application/pdfBuprenorphine_Agents_Criteria_a11y.pdf Open Download Copy Link 289.92 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Buprenorphine_Agents_Criteria_a11y_PAC_UA_Report.pdf
application/pdfBuprenorphine_Agents_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 244.76 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Butalbital_Criteria_a11y.pdf
application/pdfButalbital_Criteria_a11y.pdf Open Download Copy Link 350.33 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Butalbital_Criteria_a11y_PAC_UA_Report.pdf
application/pdfButalbital_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 253.33 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Bydureon_Bcise_Criteria_a11y.pdf
application/pdfBydureon_Bcise_Criteria_a11y.pdf Open Download Copy Link 289.35 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Bydureon_Bcise_Criteria_a11y_PAC_UA_Report.pdf
application/pdfBydureon_Bcise_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 233.37 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cabenuva_Criteria_a11y.pdf
application/pdfCabenuva_Criteria_a11y.pdf Open Download Copy Link 300.41 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cabenuva_Criteria_a11y_PAC_UA_Report.pdf
application/pdfCabenuva_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 241.53 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Caplyta_Criteria_a11y.pdf
application/pdfCaplyta_Criteria_a11y.pdf Open Download Copy Link 383.32 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Caplyta_Criteria_a11y_PAC_UA_Report.pdf
application/pdfCaplyta_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 241.35 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Carbaglu_Crtieria_a11y.pdf
application/pdfCarbaglu_Crtieria_a11y.pdf Open Download Copy Link 333.17 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Carbaglu_Crtieria_a11y_PAC_UA_Report.pdf
application/pdfCarbaglu_Crtieria_a11y_PAC_UA_Report.pdf Open Download Copy Link 243.26 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Carvykti_Criteria_a11y.pdf
application/pdfCarvykti_Criteria_a11y.pdf Open Download Copy Link 303.32 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Carvykti_Criteria_a11y_PAC_UA_Report.pdf
application/pdfCarvykti_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 236.94 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cayston_Criteria_a11y.pdf
application/pdfCayston_Criteria_a11y.pdf Open Download Copy Link 305 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cayston_Criteria_a11y_PAC_UA_Report.pdf
application/pdfCayston_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 248.9 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Ceprotin_Criteria_a11y.pdf
application/pdfCeprotin_Criteria_a11y.pdf Open Download Copy Link 296.76 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Ceprotin_Criteria_a11y_PAC_UA_Report.pdf
application/pdfCeprotin_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 236.36 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cerdelga_Criteria_a11y.pdf
application/pdfCerdelga_Criteria_a11y.pdf Open Download Copy Link 282.63 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cerdelga_Criteria_a11y_PAC_UA_Report.pdf
application/pdfCerdelga_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 222.41 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cerezyme_Criteria_a11y.pdf
application/pdfCerezyme_Criteria_a11y.pdf Open Download Copy Link 298.69 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cerezyme_Criteria_a11y_PAC_UA_Report.pdf
application/pdfCerezyme_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 229.02 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Chantix_Criteria_a11y.pdf
application/pdfChantix_Criteria_a11y.pdf Open Download Copy Link 295.03 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Chantix_Criteria_a11y_PAC_UA_Report.pdf
application/pdfChantix_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 231.52 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Chemet_Criteria_a11y.pdf
application/pdfChemet_Criteria_a11y.pdf Open Download Copy Link 294.21 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Chemet_Criteria_a11y_PAC_UA_Report.pdf
application/pdfChemet_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 236.12 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Chorionic_Gonadotropin_Criteria_a11y.pdf
application/pdfChorionic_Gonadotropin_Criteria_a11y.pdf Open Download Copy Link 297.24 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Chorionic_Gonadotropin_Criteria_a11y_PAC_UA_Report.pdf
application/pdfChorionic_Gonadotropin_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 246.48 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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CII-V_Edit_Override_Criteria_a11y.pdf
application/pdfCII-V_Edit_Override_Criteria_a11y.pdf Open Download Copy Link 313.27 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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CII-V_Edit_Override_Criteria_a11y_PAC_UA_Report.pdf
application/pdfCII-V_Edit_Override_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 270.16 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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CINQAIR_Criteria_a11y.pdf
application/pdfCINQAIR_Criteria_a11y.pdf Open Download Copy Link 306.36 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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CINQAIR_Criteria_a11y_PAC_UA_Report.pdf
application/pdfCINQAIR_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 261.29 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cinryze_Criteria_a11y.pdf
application/pdfCinryze_Criteria_a11y.pdf Open Download Copy Link 290.92 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cinryze_Criteria_a11y_PAC_UA_Report.pdf
application/pdfCinryze_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 225.8 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Colchicine_Agents_Criteria_a11y.pdf
application/pdfColchicine_Agents_Criteria_a11y.pdf Open Download Copy Link 303.26 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Colchicine_Agents_Criteria_a11y_PAC_UA_Report.pdf
application/pdfColchicine_Agents_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 257.92 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Concomitant_Drug_Therapy_Overlap_Criteria_a11y.pdf
application/pdfConcomitant_Drug_Therapy_Overlap_Criteria_a11y.pdf Open Download Copy Link 290.87 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Concomitant_Drug_Therapy_Overlap_Criteria_a11y_PAC_UA_Report.pdf
application/pdfConcomitant_Drug_Therapy_Overlap_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 237.23 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Constipation_Agents_a11y.pdf
application/pdfConstipation_Agents_a11y.pdf Open Download Copy Link 302.49 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Constipation_Agents_a11y_PAC_UA_Report.pdf
application/pdfConstipation_Agents_a11y_PAC_UA_Report.pdf Open Download Copy Link 274.49 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Corlanor_Criteria_a11y.pdf
application/pdfCorlanor_Criteria_a11y.pdf Open Download Copy Link 319.72 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Corlanor_Criteria_a11y_PAC_UA_Report.pdf
application/pdfCorlanor_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 260.26 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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COUGH_MEDS_Criteria_a11y.pdf
application/pdfCOUGH_MEDS_Criteria_a11y.pdf Open Download Copy Link 279.52 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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COUGH_MEDS_Criteria_a11y_PAC_UA_Report.pdf
application/pdfCOUGH_MEDS_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 217.5 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Crysvita_Criteria_a11y.pdf
application/pdfCrysvita_Criteria_a11y.pdf Open Download Copy Link 345.1 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Crysvita_Criteria_a11y_PAC_UA_Report.pdf
application/pdfCrysvita_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 259.64 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cubicin_Criteria_a11y.pdf
application/pdfCubicin_Criteria_a11y.pdf Open Download Copy Link 370.14 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cubicin_Criteria_a11y_PAC_UA_Report.pdf
application/pdfCubicin_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 274.13 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cyanocablamin_Criteria_a11y.pdf
application/pdfCyanocablamin_Criteria_a11y.pdf Open Download Copy Link 224.52 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cyanocablamin_Criteria_a11y_PAC_UA_Report.pdf
application/pdfCyanocablamin_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 225.56 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cyramza_Criteria_a11y.pdf
application/pdfCyramza_Criteria_a11y.pdf Open Download Copy Link 343.67 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cyramza_Criteria_a11y_PAC_UA_Report.pdf
application/pdfCyramza_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 277.69 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cytogam_Form_a11y.pdf
application/pdfCytogam_Form_a11y.pdf Open Download Copy Link 1.31 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cytogam_Form_a11y_PAC_UA_Report.pdf
application/pdfCytogam_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 293.31 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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CYTOKINES_AND_CAM_ANTAGONISTS_08_26_2021_a11y.pdf
application/pdfCYTOKINES_AND_CAM_ANTAGONISTS_08_26_2021_a11y.pdf Open Download Copy Link 471.97 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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CYTOKINES_AND_CAM_ANTAGONISTS_08_26_2021_a11y_PAC_UA_Report.pdf
application/pdfCYTOKINES_AND_CAM_ANTAGONISTS_08_26_2021_a11y_PAC_UA_Report.pdf Open Download Copy Link 281.23 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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FL_PA_Colony_Stimulating_Factors_Form_a11y.pdf
application/pdfFL_PA_Colony_Stimulating_Factors_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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FL_PA_Colony_Stimulating_Factors_Form_a11y_PAC_UA_Report.pdf
application/pdfFL_PA_Colony_Stimulating_Factors_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 309.06 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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