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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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Daliresp_Criteria_a11y.pdf

Open Download Copy Link 227.67 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
227.67 KBOctober 28, 2022
Daliresp_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 221.83 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
221.83 KBOctober 28, 2022
Dalvance_Criteria_a11y.pdf

Open Download Copy Link 308.81 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
308.81 KBOctober 28, 2022
Dalvance_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
233.37 KBOctober 28, 2022
Daraprim_Criteria_a11y.pdf

Open Download Copy Link 362.41 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
362.41 KBOctober 28, 2022
Daraprim_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 276.65 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
276.65 KBOctober 28, 2022
Diacomit_Criteria_a11y.pdf

Open Download Copy Link 326.87 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
326.87 KBOctober 28, 2022
Diacomit_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 234.45 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
234.45 KBOctober 28, 2022
Dibenzyline_Criteria_a11y.pdf

Open Download Copy Link 431.33 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
431.33 KBOctober 28, 2022
Dibenzyline_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 236.8 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
236.8 KBOctober 28, 2022
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