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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FL_PA_Opioid_Form_a11y.pdf
application/pdfFL_PA_Opioid_Form_a11y.pdf Open Download Copy Link 1.26 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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FL_PA_Opioid_Form_a11y_PAC_UA_Report.pdf
application/pdfFL_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 |
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Ocreotides_and_Related_Class_Criteria_01_19_2021_a11y.pdf
application/pdfOcreotides_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 |
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Ocreotides_and_Related_Class_Criteria_01_19_2021_a11y_PAC_UA_Report.pdf
application/pdfOcreotides_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 |
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Ofev_Criteria_a11y.pdf
application/pdfOfev_Criteria_a11y.pdf Open Download Copy Link 541.06 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Ofev_Criteria_a11y_PAC_UA_Report.pdf
application/pdfOfev_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 |
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Off_Label_Use_Criteria_a11y.pdf
application/pdfOff_Label_Use_Criteria_a11y.pdf Open Download Copy Link 486.2 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Off_Label_Use_Criteria_a11y_PAC_UA_Report.pdf
application/pdfOff_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 |
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Opzelura_Criteria_a11y.pdf
application/pdfOpzelura_Criteria_a11y.pdf Open Download Copy Link 321.15 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Opzelura_Criteria_a11y_PAC_UA_Report.pdf
application/pdfOpzelura_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 |
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Oralair_Criteria_a11y.pdf
application/pdfOralair_Criteria_a11y.pdf Open Download Copy Link 449.13 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Oralair_Criteria_a11y_PAC_UA_Report.pdf
application/pdfOralair_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 248.62 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Oral_Oncology_Agents_Form_a11y.pdf
application/pdfOral_Oncology_Agents_Form_a11y.pdf Open Download Copy Link 1.58 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Oral_Oncology_Agents_Form_a11y_PAC_UA_Report.pdf
application/pdfOral_Oncology_Agents_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 297.92 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Oral_Oncology_Criteria_a11y.pdf
application/pdfOral_Oncology_Criteria_a11y.pdf Open Download Copy Link 767.3 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Oral_Oncology_Criteria_a11y_PAC_UA_Report.pdf
application/pdfOral_Oncology_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 253.93 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Oravig_Criteria_a11y.pdf
application/pdfOravig_Criteria_a11y.pdf Open Download Copy Link 539.55 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Oravig_Criteria_a11y_PAC_UA_Report.pdf
application/pdfOravig_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 |
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Oriahnn_Criteria_a11y.pdf
application/pdfOriahnn_Criteria_a11y.pdf Open Download Copy Link 431.67 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Oriahnn_Criteria_a11y_PAC_UA_Report.pdf
application/pdfOriahnn_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 239.16 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Orilissa_Criteria_a11y.pdf
application/pdfOrilissa_Criteria_a11y.pdf Open Download Copy Link 568.34 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Orilissa_Criteria_a11y_PAC_UA_Report.pdf
application/pdfOrilissa_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 225.35 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Orkambi_Criteria_a11y.pdf
application/pdfOrkambi_Criteria_a11y.pdf Open Download Copy Link 742.86 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Orkambi_Criteria_a11y_PAC_UA_Report.pdf
application/pdfOrkambi_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 268.07 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Orladeyo_Criteria_a11y.pdf
application/pdfOrladeyo_Criteria_a11y.pdf Open Download Copy Link 442.13 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Orladeyo_Criteria_a11y_PAC_UA_Report.pdf
application/pdfOrladeyo_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 217.59 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Ortikos_Criteria_a11y.pdf
application/pdfOrtikos_Criteria_a11y.pdf Open Download Copy Link 489.38 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Ortikos_Criteria_a11y_PAC_UA_Report.pdf
application/pdfOrtikos_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 229.04 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Otrexup_Criteria_a11y.pdf
application/pdfOtrexup_Criteria_a11y.pdf Open Download Copy Link 579.88 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Otrexup_Criteria_a11y_PAC_UA_Report.pdf
application/pdfOtrexup_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 257.95 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Overactive_Bladder_Agents_Criteria_a11y.pdf
application/pdfOveractive_Bladder_Agents_Criteria_a11y.pdf Open Download Copy Link 447 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Overactive_Bladder_Agents_Criteria_a11y_PAC_UA_Report.pdf
application/pdfOveractive_Bladder_Agents_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 257.88 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Oxandrin_Criteria_a11y.pdf
application/pdfOxandrin_Criteria_a11y.pdf Open Download Copy Link 502.03 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Oxandrin_Criteria_a11y_PAC_UA_Report.pdf
application/pdfOxandrin_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 241.05 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Oxbryta_Criteria_a11y.pdf
application/pdfOxbryta_Criteria_a11y.pdf Open Download Copy Link 501.94 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Oxbryta_Criteria_a11y_PAC_UA_Report.pdf
application/pdfOxbryta_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 255.92 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Oxlumo_Criteria_a11y.pdf
application/pdfOxlumo_Criteria_a11y.pdf Open Download Copy Link 456.85 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Oxlumo_Criteria_a11y_PAC_UA_Report.pdf
application/pdfOxlumo_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 230.76 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Palforzia_Criteria_a11y.pdf
application/pdfPalforzia_Criteria_a11y.pdf Open Download Copy Link 512.1 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Palforzia_Criteria_a11y_PAC_UA_Report.pdf
application/pdfPalforzia_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 275.29 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Palynziq_Criteria_a11y.pdf
application/pdfPalynziq_Criteria_a11y.pdf Open Download Copy Link 601.86 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Palynziq_Criteria_a11y_PAC_UA_Report.pdf
application/pdfPalynziq_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 239.92 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Panretin_Form_a11y.pdf
application/pdfPanretin_Form_a11y.pdf Open Download Copy Link 1.68 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Panretin_Form_a11y_PAC_UA_Report.pdf
application/pdfPanretin_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 287.61 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Pompe_Disease_Agents_Criteria_a11y.pdf
application/pdfPompe_Disease_Agents_Criteria_a11y.pdf Open Download Copy Link 433.16 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Pompe_Disease_Agents_Criteria_a11y_PAC_UA_Report.pdf
application/pdfPompe_Disease_Agents_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 236.31 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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PPI_greater_than_6_months_Criteria_a11y.pdf
application/pdfPPI_greater_than_6_months_Criteria_a11y.pdf Open Download Copy Link 734.92 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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PPI_greater_than_6_months_Criteria_a11y_PAC_UA_Report.pdf
application/pdfPPI_greater_than_6_months_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 275.67 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Praluent_Criteria_a11y.pdf
application/pdfPraluent_Criteria_a11y.pdf Open Download Copy Link 445.72 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Praluent_Criteria_a11y_PAC_UA_Report.pdf
application/pdfPraluent_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 278.6 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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ProCentra_Criteria_a11y.pdf
application/pdfProCentra_Criteria_a11y.pdf Open Download Copy Link 573.95 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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ProCentra_Criteria_a11y_PAC_UA_Report.pdf
application/pdfProCentra_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 239.6 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Proleukin_Form_a11y.pdf
application/pdfProleukin_Form_a11y.pdf Open Download Copy Link 1.69 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Proleukin_Form_a11y_PAC_UA_Report.pdf
application/pdfProleukin_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 285.19 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Prolia_Criteria_a11y.pdf
application/pdfProlia_Criteria_a11y.pdf Open Download Copy Link 480.74 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Prolia_Criteria_a11y_PAC_UA_Report.pdf
application/pdfProlia_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 271.6 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Pulmonary_Hypertension_Agent_Criteria_a11y.pdf
application/pdfPulmonary_Hypertension_Agent_Criteria_a11y.pdf Open Download Copy Link 444.7 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Pulmonary_Hypertension_Agent_Criteria_a11y_PAC_UA_Report.pdf
application/pdfPulmonary_Hypertension_Agent_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 251.9 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Pyrukynd_Criteria_a11y.pdf
application/pdfPyrukynd_Criteria_a11y.pdf Open Download Copy Link 464.3 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Pyrukynd_Criteria_a11y_PAC_UA_Report.pdf
application/pdfPyrukynd_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 247.18 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Rasuvo_Criteria_a11y.pdf
application/pdfRasuvo_Criteria_a11y.pdf Open Download Copy Link 553.82 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Rasuvo_Criteria_a11y_PAC_UA_Report.pdf
application/pdfRasuvo_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 260.12 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Ravicti_Criteria_a11y.pdf
application/pdfRavicti_Criteria_a11y.pdf Open Download Copy Link 607.21 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Ravicti_Criteria_a11y_PAC_UA_Report.pdf
application/pdfRavicti_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 252.43 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Reblozyl_Criteria_a11y.pdf
application/pdfReblozyl_Criteria_a11y.pdf Open Download Copy Link 654.48 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Reblozyl_Criteria_a11y_PAC_UA_Report.pdf
application/pdfReblozyl_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 262.46 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Recorlev_Criteria_a11y.pdf
application/pdfRecorlev_Criteria_a11y.pdf Open Download Copy Link 422.11 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Recorlev_Criteria_a11y_PAC_UA_Report.pdf
application/pdfRecorlev_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 228.16 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Rectiv_Criteria_a11y.pdf
application/pdfRectiv_Criteria_a11y.pdf Open Download Copy Link 586.99 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Rectiv_Criteria_a11y_PAC_UA_Report.pdf
application/pdfRectiv_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 231.24 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Regranex_Criteria_a11y.pdf
application/pdfRegranex_Criteria_a11y.pdf Open Download Copy Link 552.86 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Regranex_Criteria_a11y_PAC_UA_Report.pdf
application/pdfRegranex_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 228.62 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Repatha_Criteria_a11y.pdf
application/pdfRepatha_Criteria_a11y.pdf Open Download Copy Link 467.12 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Repatha_Criteria_a11y_PAC_UA_Report.pdf
application/pdfRepatha_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 269.11 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Revcovi_Criteria_a11y.pdf
application/pdfRevcovi_Criteria_a11y.pdf Open Download Copy Link 438.87 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Revcovi_Criteria_a11y_PAC_UA_Report.pdf
application/pdfRevcovi_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 241.32 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Rexulti_Criteria_a11y.pdf
application/pdfRexulti_Criteria_a11y.pdf Open Download Copy Link 457.11 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Rexulti_Criteria_a11y_PAC_UA_Report.pdf
application/pdfRexulti_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 242.7 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Reyvow_Criteria_a11y.pdf
application/pdfReyvow_Criteria_a11y.pdf Open Download Copy Link 436.71 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Reyvow_Criteria_a11y_PAC_UA_Report.pdf
application/pdfReyvow_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 235.39 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Rezurock_Criteria_a11y.pdf
application/pdfRezurock_Criteria_a11y.pdf Open Download Copy Link 442.67 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Rezurock_Criteria_a11y_PAC_UA_Report.pdf
application/pdfRezurock_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 231.27 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Ruconest_Criteria_a11y.pdf
application/pdfRuconest_Criteria_a11y.pdf Open Download Copy Link 578.22 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Ruconest_Criteria_a11y_PAC_UA_Report.pdf
application/pdfRuconest_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 221.5 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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