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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Daliresp_Criteria_a11y.pdf
application/pdfDaliresp_Criteria_a11y.pdf Open Download Copy Link 227.67 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Daliresp_Criteria_a11y_PAC_UA_Report.pdf
application/pdfDaliresp_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 |
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Dalvance_Criteria_a11y.pdf
application/pdfDalvance_Criteria_a11y.pdf Open Download Copy Link 308.81 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Dalvance_Criteria_a11y_PAC_UA_Report.pdf
application/pdfDalvance_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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Daraprim_Criteria_a11y.pdf
application/pdfDaraprim_Criteria_a11y.pdf Open Download Copy Link 362.41 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Daraprim_Criteria_a11y_PAC_UA_Report.pdf
application/pdfDaraprim_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 |
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Diacomit_Criteria_a11y.pdf
application/pdfDiacomit_Criteria_a11y.pdf Open Download Copy Link 326.87 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Diacomit_Criteria_a11y_PAC_UA_Report.pdf
application/pdfDiacomit_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 |
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Dibenzyline_Criteria_a11y.pdf
application/pdfDibenzyline_Criteria_a11y.pdf Open Download Copy Link 431.33 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Dibenzyline_Criteria_a11y_PAC_UA_Report.pdf
application/pdfDibenzyline_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 |
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Dificid_Criteria_a11y.pdf
application/pdfDificid_Criteria_a11y.pdf Open Download Copy Link 333.51 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Dificid_Criteria_a11y_PAC_UA_Report.pdf
application/pdfDificid_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 247.38 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Dojolvi_Criteria_a11y.pdf
application/pdfDojolvi_Criteria_a11y.pdf Open Download Copy Link 360.45 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Dojolvi_Criteria_a11y_PAC_UA_Report.pdf
application/pdfDojolvi_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 232.22 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Dupixent_Criteria_a11y.pdf
application/pdfDupixent_Criteria_a11y.pdf Open Download Copy Link 339.5 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Dupixent_Criteria_a11y_PAC_UA_Report.pdf
application/pdfDupixent_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 268.47 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Edurant_Criteria_a11y.pdf
application/pdfEdurant_Criteria_a11y.pdf Open Download Copy Link 546.73 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Edurant_Criteria_a11y_PAC_UA_Report.pdf
application/pdfEdurant_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 269.17 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Elaprase_Criteria_a11y.pdf
application/pdfElaprase_Criteria_a11y.pdf Open Download Copy Link 431.46 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Elaprase_Criteria_a11y_PAC_UA_Report.pdf
application/pdfElaprase_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 232.34 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Elmiron_Criteria_a11y.pdf
application/pdfElmiron_Criteria_a11y.pdf Open Download Copy Link 497.03 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Elmiron_Criteria_a11y_PAC_UA_Report.pdf
application/pdfElmiron_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 220.76 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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EMFLAZA_a11y.pdf
application/pdfEMFLAZA_a11y.pdf Open Download Copy Link 476.07 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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EMFLAZA_a11y_PAC_UA_Report.pdf
application/pdfEMFLAZA_a11y_PAC_UA_Report.pdf Open Download Copy Link 230.7 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Empaveli_Criteria_a11y.pdf
application/pdfEmpaveli_Criteria_a11y.pdf Open Download Copy Link 350.25 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Empaveli_Criteria_a11y_PAC_UA_Report.pdf
application/pdfEmpaveli_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 244.44 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Endari_Criteria_a11y.pdf
application/pdfEndari_Criteria_a11y.pdf Open Download Copy Link 305.53 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Endari_Criteria_a11y_PAC_UA_Report.pdf
application/pdfEndari_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 239.53 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Enjaymo_Criteria_a11y.pdf
application/pdfEnjaymo_Criteria_a11y.pdf Open Download Copy Link 302.12 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Enjaymo_Criteria_a11y_PAC_UA_Report.pdf
application/pdfEnjaymo_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 223.03 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Enspryng_Criteria_a11y.pdf
application/pdfEnspryng_Criteria_a11y.pdf Open Download Copy Link 332.72 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Enspryng_Criteria_a11y_PAC_UA_Report.pdf
application/pdfEnspryng_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 268.95 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Epaned_Criteria_a11y.pdf
application/pdfEpaned_Criteria_a11y.pdf Open Download Copy Link 433.18 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Epaned_Criteria_a11y_PAC_UA_Report.pdf
application/pdfEpaned_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 239.3 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Erwinaze_Criteria_a11y.pdf
application/pdfErwinaze_Criteria_a11y.pdf Open Download Copy Link 456.17 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Erwinaze_Criteria_a11y_PAC_UA_Report.pdf
application/pdfErwinaze_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 248.31 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Erythropoiesis_Stimulating_Agents_Criteria_a11y.pdf
application/pdfErythropoiesis_Stimulating_Agents_Criteria_a11y.pdf Open Download Copy Link 430.56 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Erythropoiesis_Stimulating_Agents_Criteria_a11y_PAC_UA_Report.pdf
application/pdfErythropoiesis_Stimulating_Agents_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 257.37 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Esbriet_Criteria_a11y.pdf
application/pdfEsbriet_Criteria_a11y.pdf Open Download Copy Link 480.79 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Esbriet_Criteria_a11y_PAC_UA_Report.pdf
application/pdfEsbriet_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 240.54 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Evkeeza_Criteria_a11y.pdf
application/pdfEvkeeza_Criteria_a11y.pdf Open Download Copy Link 356.47 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Evkeeza_Criteria_a11y_PAC_UA_Report.pdf
application/pdfEvkeeza_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 249.3 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Evrysdi_Criteria_a11y.pdf
application/pdfEvrysdi_Criteria_a11y.pdf Open Download Copy Link 337.94 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Evrysdi_Criteria_a11y_PAC_UA_Report.pdf
application/pdfEvrysdi_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 264.22 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Exjade_Criteria_a11y.pdf
application/pdfExjade_Criteria_a11y.pdf Open Download Copy Link 317.57 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Exjade_Criteria_a11y_PAC_UA_Report.pdf
application/pdfExjade_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 267.7 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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EXONDYS51_Criteria_a11y.pdf
application/pdfEXONDYS51_Criteria_a11y.pdf Open Download Copy Link 337 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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EXONDYS51_Criteria_a11y_PAC_UA_Report.pdf
application/pdfEXONDYS51_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 261.28 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Exondys_Form_a11y.pdf
application/pdfExondys_Form_a11y.pdf Open Download Copy Link 1.23 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Exondys_Form_a11y_PAC_UA_Report.pdf
application/pdfExondys_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 291.56 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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FASENRA_Criteria_a11y.pdf
application/pdfFASENRA_Criteria_a11y.pdf Open Download Copy Link 476.83 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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FASENRA_Criteria_a11y_PAC_UA_Report.pdf
application/pdfFASENRA_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 264.32 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Fensolvi_02_01_2022_a11y.pdf
application/pdfFensolvi_02_01_2022_a11y.pdf Open Download Copy Link 305.75 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Fensolvi_02_01_2022_a11y_PAC_UA_Report.pdf
application/pdfFensolvi_02_01_2022_a11y_PAC_UA_Report.pdf Open Download Copy Link 247.7 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Ferriprox_Criteria_a11y.pdf
application/pdfFerriprox_Criteria_a11y.pdf Open Download Copy Link 358.31 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Ferriprox_Criteria_a11y_PAC_UA_Report.pdf
application/pdfFerriprox_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 248.88 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Fetzima_Criteria_a11y.pdf
application/pdfFetzima_Criteria_a11y.pdf Open Download Copy Link 512.73 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Fetzima_Criteria_a11y_PAC_UA_Report.pdf
application/pdfFetzima_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 246.12 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Fintepla_Criteria_a11y.pdf
application/pdfFintepla_Criteria_a11y.pdf Open Download Copy Link 306.4 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Fintepla_Criteria_a11y_PAC_UA_Report.pdf
application/pdfFintepla_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 240.41 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Firvanq_Criteria_a11y.pdf
application/pdfFirvanq_Criteria_a11y.pdf Open Download Copy Link 344.64 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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FL_PA_Erythropoeisis_Stimulating_Agents_a11y.pdf
application/pdfFL_PA_Erythropoeisis_Stimulating_Agents_a11y.pdf Open Download Copy Link 1.27 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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FL_PA_Erythropoeisis_Stimulating_Agents_a11y_PAC_UA_Report.pdf
application/pdfFL_PA_Erythropoeisis_Stimulating_Agents_a11y_PAC_UA_Report.pdf Open Download Copy Link 310.98 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Forteo_Criteria_a11y.pdf
application/pdfForteo_Criteria_a11y.pdf Open Download Copy Link 376.98 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Forteo_Criteria_a11y_PAC_UA_Report.pdf
application/pdfForteo_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 272.67 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Fuzeon_Form_a11y.pdf
application/pdfFuzeon_Form_a11y.pdf Open Download Copy Link 1.28 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Fuzeon_Form_a11y_PAC_UA_Report.pdf
application/pdfFuzeon_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 301.55 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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