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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Katerzia_Criteria_a11y.pdf
application/pdfKaterzia_Criteria_a11y.pdf Open Download Copy Link 342.53 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Katerzia_Criteria_a11y_PAC_UA_Report.pdf
application/pdfKaterzia_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 238.35 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Lacrisert_Criteria_a11y.pdf
application/pdfLacrisert_Criteria_a11y.pdf Open Download Copy Link 569.1 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Lacrisert_Criteria_a11y_PAC_UA_Report.pdf
application/pdfLacrisert_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 226.6 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Lampit_Criteria_a11y.pdf
application/pdfLampit_Criteria_a11y.pdf Open Download Copy Link 338.64 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Lampit_Criteria_a11y_PAC_UA_Report.pdf
application/pdfLampit_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 222.85 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Lioresal_and_Gablofen_Criteria_a11y.pdf
application/pdfLioresal_and_Gablofen_Criteria_a11y.pdf Open Download Copy Link 364.15 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Lioresal_and_Gablofen_Criteria_a11y_PAC_UA_Report.pdf
application/pdfLioresal_and_Gablofen_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 262.55 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Livtencity_Criteria_a11y.pdf
application/pdfLivtencity_Criteria_a11y.pdf Open Download Copy Link 358.65 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Livtencity_Criteria_a11y_PAC_UA_Report.pdf
application/pdfLivtencity_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 230.88 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Long_Acting_Beta_2_Agonists_Criteria_a11y.pdf
application/pdfLong_Acting_Beta_2_Agonists_Criteria_a11y.pdf Open Download Copy Link 331.3 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Long_Acting_Beta_2_Agonists_Criteria_a11y_PAC_UA_Report.pdf
application/pdfLong_Acting_Beta_2_Agonists_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 238.21 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Long_Acting_Stimulant_Criteria_a11y.pdf
application/pdfLong_Acting_Stimulant_Criteria_a11y.pdf Open Download Copy Link 396.36 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Long_Acting_Stimulant_Criteria_a11y_PAC_UA_Report.pdf
application/pdfLong_Acting_Stimulant_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 270.14 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Lovaza_Criteria_a11y.pdf
application/pdfLovaza_Criteria_a11y.pdf Open Download Copy Link 324.93 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Lovaza_Criteria_a11y_PAC_UA_Report.pdf
application/pdfLovaza_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 233.55 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Lucemyra_Criteria_a11y.pdf
application/pdfLucemyra_Criteria_a11y.pdf Open Download Copy Link 314.76 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Lucemyra_Criteria_a11y_PAC_UA_Report.pdf
application/pdfLucemyra_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 234.06 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Lupkynis_Criteria_a11y.pdf
application/pdfLupkynis_Criteria_a11y.pdf Open Download Copy Link 321.55 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Lupkynis_Criteria_a11y_PAC_UA_Report.pdf
application/pdfLupkynis_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 243.22 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Luxturna_Criteria_a11y.pdf
application/pdfLuxturna_Criteria_a11y.pdf Open Download Copy Link 515.73 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Luxturna_Criteria_a11y_PAC_UA_Report.pdf
application/pdfLuxturna_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 239.63 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Lybalvi_Criteria_a11y.pdf
application/pdfLybalvi_Criteria_a11y.pdf Open Download Copy Link 368.12 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Lybalvi_Criteria_a11y_PAC_UA_Report.pdf
application/pdfLybalvi_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 256.51 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Makena_Criteria_a11y.pdf
application/pdfMakena_Criteria_a11y.pdf Open Download Copy Link 401.45 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Makena_Criteria_a11y_PAC_UA_Report.pdf
application/pdfMakena_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 269.07 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Marinol_Criteria_a11y.pdf
application/pdfMarinol_Criteria_a11y.pdf Open Download Copy Link 479.81 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Marinol_Criteria_a11y_PAC_UA_Report.pdf
application/pdfMarinol_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 243.33 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Mepsevii_Criteria_a11y.pdf
application/pdfMepsevii_Criteria_a11y.pdf Open Download Copy Link 442.31 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Mepsevii_Criteria_a11y_PAC_UA_Report.pdf
application/pdfMepsevii_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 217.39 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Methadone_Criteria_a11y.pdf
application/pdfMethadone_Criteria_a11y.pdf Open Download Copy Link 704.95 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Methadone_Criteria_a11y_PAC_UA_Report.pdf
application/pdfMethadone_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 278.32 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Miscellaneous_Criteria_a11y.pdf
application/pdfMiscellaneous_Criteria_a11y.pdf Open Download Copy Link 468.73 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Miscellaneous_Criteria_a11y_PAC_UA_Report.pdf
application/pdfMiscellaneous_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 261.99 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Mozobil_Criteria_a11y.pdf
application/pdfMozobil_Criteria_a11y.pdf Open Download Copy Link 492.9 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Mozobil_Criteria_a11y_PAC_UA_Report.pdf
application/pdfMozobil_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 234.21 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Multiple_Sclerosis_Oral_Agents_Criteria_a11y.pdf
application/pdfMultiple_Sclerosis_Oral_Agents_Criteria_a11y.pdf Open Download Copy Link 361.81 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Multiple_Sclerosis_Oral_Agents_Criteria_a11y_PAC_UA_Report.pdf
application/pdfMultiple_Sclerosis_Oral_Agents_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 259.43 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Multi_Source_Brand_Drug_Form_a11y.pdf
application/pdfMulti_Source_Brand_Drug_Form_a11y.pdf Open Download Copy Link 811.96 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Multi_Source_Brand_Drug_Form_a11y_PAC_UA_Report.pdf
application/pdfMulti_Source_Brand_Drug_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 301.01 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Myalept_Criteria_a11y.pdf
application/pdfMyalept_Criteria_a11y.pdf Open Download Copy Link 501.68 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Myalept_Criteria_a11y_PAC_UA_Report.pdf
application/pdfMyalept_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 257.86 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Myfembree_Criteria_a11y.pdf
application/pdfMyfembree_Criteria_a11y.pdf Open Download Copy Link 360.33 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Myfembree_Criteria_a11y_PAC_UA_Report.pdf
application/pdfMyfembree_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 239.57 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Mytesi_Criteria_a11y.pdf
application/pdfMytesi_Criteria_a11y.pdf Open Download Copy Link 360.73 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Mytesi_Criteria_a11y_PAC_UA_Report.pdf
application/pdfMytesi_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 260.36 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Namenda_XR_Criteria_a11y.pdf
application/pdfNamenda_XR_Criteria_a11y.pdf Open Download Copy Link 502.6 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Namenda_XR_Criteria_a11y_PAC_UA_Report.pdf
application/pdfNamenda_XR_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 253.44 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Natacyn_Criteria_a11y.pdf
application/pdfNatacyn_Criteria_a11y.pdf Open Download Copy Link 474.43 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Natacyn_Criteria_a11y_PAC_UA_Report.pdf
application/pdfNatacyn_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 230.62 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Neupro_Criteria_a11y.pdf
application/pdfNeupro_Criteria_a11y.pdf Open Download Copy Link 544.07 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Neupro_Criteria_a11y_PAC_UA_Report.pdf
application/pdfNeupro_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 254.16 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Nexletol-Nexlizet_Criteria_a11y.pdf
application/pdfNexletol-Nexlizet_Criteria_a11y.pdf Open Download Copy Link 343.79 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Nexletol-Nexlizet_Criteria_a11y_PAC_UA_Report.pdf
application/pdfNexletol-Nexlizet_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 |
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Nitisinone_Form_a11y.pdf
application/pdfNitisinone_Form_a11y.pdf Open Download Copy Link 1.05 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Nitisinone_Form_a11y_PAC_UA_Report.pdf
application/pdfNitisinone_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 287.46 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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NUCALA_Criteria_a11y.pdf
application/pdfNUCALA_Criteria_a11y.pdf Open Download Copy Link 416 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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NUCALA_Criteria_a11y_PAC_UA_Report.pdf
application/pdfNUCALA_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 259.71 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Nucynta_Criteria_a11y.pdf
application/pdfNucynta_Criteria_a11y.pdf Open Download Copy Link 351.71 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Nucynta_Criteria_a11y_PAC_UA_Report.pdf
application/pdfNucynta_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 226.91 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Nuplazid_Criteria_a11y.pdf
application/pdfNuplazid_Criteria_a11y.pdf Open Download Copy Link 460.53 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Nuplazid_Criteria_a11y_PAC_UA_Report.pdf
application/pdfNuplazid_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 227.77 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Pharm_Misc_Form_a11y.pdf
application/pdfPharm_Misc_Form_a11y.pdf Open Download Copy Link 972.72 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Pharm_Misc_Form_a11y_PAC_UA_Report.pdf
application/pdfPharm_Misc_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 296.5 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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