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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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Katerzia_Criteria_a11y.pdf

Open Download Copy Link 342.53 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
342.53 KBOctober 28, 2022
Katerzia_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
238.35 KBOctober 28, 2022
Lacrisert_Criteria_a11y.pdf

Open Download Copy Link 569.1 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
569.1 KBOctober 28, 2022
Lacrisert_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
226.6 KBOctober 28, 2022
Lampit_Criteria_a11y.pdf

Open Download Copy Link 338.64 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
338.64 KBOctober 28, 2022
Lampit_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
222.85 KBOctober 28, 2022
Lioresal_and_Gablofen_Criteria_a11y.pdf

Open Download Copy Link 364.15 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
364.15 KBOctober 28, 2022
Lioresal_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
262.55 KBOctober 28, 2022
Livtencity_Criteria_a11y.pdf

Open Download Copy Link 358.65 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
358.65 KBOctober 28, 2022
Livtencity_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
230.88 KBOctober 28, 2022
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