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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.

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Benlysta_Criteria_a11y.pdf

Open Download Copy Link 354.94 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
354.94 KBOctober 28, 2022
Benlysta_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
251.02 KBOctober 28, 2022
Beovu_Criteria_a11y.pdf

Open Download Copy Link 336 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
336 KBOctober 28, 2022
Beovu_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
241.91 KBOctober 28, 2022
Besemri_Criteria_a11y.pdf

Open Download Copy Link 310.42 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
310.42 KBOctober 28, 2022
Besemri_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
234.08 KBOctober 28, 2022
Bile_Salts_Agents_Criteria_a11y.pdf

Open Download Copy Link 336.02 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
336.02 KBOctober 28, 2022
Bile_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
256.19 KBOctober 28, 2022
Blincyto_Criteria_a11y.pdf

Open Download Copy Link 290.38 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
290.38 KBOctober 28, 2022
Blincyto_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
233.39 KBOctober 28, 2022
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