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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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Galafold_Criteria_a11y.pdf

Open Download Copy Link 461.01 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Galafold_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
Gamifant_Criteria_a11y.pdf

Open Download Copy Link 308.73 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Gamifant_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 270.12 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Gattex_Criteria_a11y.pdf

Open Download Copy Link 461.76 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Gattex_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 250.53 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Gimoti_Criteria_a11y.pdf

Open Download Copy Link 299.29 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Gimoti_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 223.21 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Givlaari_Criteria_a11y.pdf

Open Download Copy Link 301.89 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Givlaari_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 224.65 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Haegarda_Criteria_a11y.pdf

Open Download Copy Link 308.98 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Haegarda_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 218.54 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Hemady_Criteria_a11y.pdf

Open Download Copy Link 304.41 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Hemady_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 227.26 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Hemangeol_Criteria_a11y.pdf

Open Download Copy Link 468.59 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Hemangeol_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 255.84 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Hepatitis_C_Agents_Criteria_a11y.pdf

Open Download Copy Link 416.47 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Hepatitis_C_Agents_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 284.6 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Hep_C_Agents_Form_a11y.pdf

Open Download Copy Link 2.09 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Hep_C_Agents_Form_a11y_PAC_UA_Report.pdf

Open Download Copy Link 278.2 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
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
H_P_Acthar_Gel_Criteria_a11y.pdf

Open Download Copy Link 337.4 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
H_P_Acthar_Gel_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 264.75 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Ileal_BATIA_Criteria_a11y.pdf

Open Download Copy Link 306.47 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Ileal_BATIA_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 242.25 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Increlex_Form_a11y.pdf

Open Download Copy Link 1.59 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Increlex_Form_a11y_PAC_UA_Report.pdf

Open Download Copy Link 305.66 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Injectable_and_Intravenous_Iron_Agents_Criteria_a11y.pdf

Open Download Copy Link 357.99 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Injectable_and_Intravenous_Iron_Agents_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 259.37 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Invega_Oral_Criteria_a11y.pdf

Open Download Copy Link 358.12 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Invega_Oral_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 256.13 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Isturisa_Criteria_a11y.pdf

Open Download Copy Link 304.4 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Isturisa_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 239.58 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
IVIG_Criteria_a11y.pdf

Open Download Copy Link 620.21 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
IVIG_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 283.66 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Jadenu_Criteria_a11y.pdf

Open Download Copy Link 331.5 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Jadenu_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 266.21 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Juxtapid_criteria_a11y.pdf

Open Download Copy Link 353.27 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Juxtapid_criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 263.51 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Jynarque_Criteria_a11y.pdf

Open Download Copy Link 463.45 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Jynarque_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 223.06 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Kadcyla_Criteria_a11y.pdf

Open Download Copy Link 437.31 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Kadcyla_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 241.12 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Kalbitor_Criteria_a11y.pdf

Open Download Copy Link 461.15 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Kalbitor_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 225.41 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Kalydeco_Criteria_a11y.pdf

Open Download Copy Link 397.37 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Kalydeco_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
Kanuma_Criteria_a11y.pdf

Open Download Copy Link 303.29 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Kanuma_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 228.74 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Kapvay_Crtieria_a11y.pdf

Open Download Copy Link 481.88 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Kapvay_Crtieria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 250.27 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Kepivance_Criteria_a11y.pdf

Open Download Copy Link 339.15 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Kepivance_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 237.01 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Kerendia_Criteria_a11y.pdf

Open Download Copy Link 329.88 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Kerendia_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 239.08 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Kimmtrax_Criteria_a11y.pdf

Open Download Copy Link 341.98 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Kimmtrax_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 231.8 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Kimyrsa_and_Orbactiv_Criteria_a11y.pdf

Open Download Copy Link 303.54 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Kimyrsa_and_Orbactiv_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 227.55 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Korlym_Criteria_a11y.pdf

Open Download Copy Link 442.37 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Korlym_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 231.85 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Krystexxa_Criteria_a11y.pdf

Open Download Copy Link 340.78 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Krystexxa_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 229.5 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Kuvan_Criteria_a11y.pdf

Open Download Copy Link 436.42 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Kuvan_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 262.48 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
KYMRIAH_criteria_a11y.pdf

Open Download Copy Link 479.94 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
KYMRIAH_criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 262.76 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022

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