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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Hetlioz_Criteria_a11y.pdf

Open Download Copy Link 338.62 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Hetlioz_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 248.05 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
HIV-HEPB_AutoPA_a11y.pdf

Open Download Copy Link 295.83 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
HIV-HEPB_AutoPA_a11y_PAC_UA_Report.pdf

Open Download Copy Link 264.65 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
HIV_Diagnosis_Verification_Form_a11y.pdf

Open Download Copy Link 1.72 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
HIV_Diagnosis_Verification_Form_a11y_PAC_UA_Report.pdf

Open Download Copy Link 298.48 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Human_Growth_Hormone_Criteria_a11y.pdf

Open Download Copy Link 485.72 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Human_Growth_Hormone_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 261.35 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Human_Growth_Hormore_Form_a11y.pdf

Open Download Copy Link 1.58 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Human_Growth_Hormore_Form_a11y_PAC_UA_Report.pdf

Open Download Copy Link 280.72 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
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