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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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FL_PA_Opioid_Form_a11y.pdf

Open Download Copy Link 1.26 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
1.26 MBOctober 28, 2022
FL_PA_Opioid_Form_a11y_PAC_UA_Report.pdf

Open Download Copy Link 267.95 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
267.95 KBOctober 28, 2022
Ocreotides_and_Related_Class_Criteria_01_19_2021_a11y.pdf

Open Download Copy Link 362.63 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
362.63 KBOctober 28, 2022
Ocreotides_and_Related_Class_Criteria_01_19_2021_a11y_PAC_UA_Report.pdf

Open Download Copy Link 252.36 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
252.36 KBOctober 28, 2022
Ofev_Criteria_a11y.pdf

Open Download Copy Link 541.06 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
541.06 KBOctober 28, 2022
Ofev_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 272.34 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
272.34 KBOctober 28, 2022
Off_Label_Use_Criteria_a11y.pdf

Open Download Copy Link 486.2 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
486.2 KBOctober 28, 2022
Off_Label_Use_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 234.7 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
234.7 KBOctober 28, 2022
Opzelura_Criteria_a11y.pdf

Open Download Copy Link 321.15 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
321.15 KBOctober 28, 2022
Opzelura_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 227.15 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
227.15 KBOctober 28, 2022
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