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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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Samsca_Criteria_a11y.pdf

Open Download Copy Link 708.75 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
708.75 KBOctober 28, 2022
Samsca_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 243.99 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
243.99 KBOctober 28, 2022
Sancuso_Criteria_a11y.pdf

Open Download Copy Link 539.39 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
539.39 KBOctober 28, 2022
Sancuso_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 240.07 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
240.07 KBOctober 28, 2022
Saphnelo_Criteria_a11y.pdf

Open Download Copy Link 428.75 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
428.75 KBOctober 28, 2022
Saphnelo_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 232.98 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
232.98 KBOctober 28, 2022
Saphris_Criteria_a11y.pdf

Open Download Copy Link 461.85 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
461.85 KBOctober 28, 2022
Saphris_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
247.18 KBOctober 28, 2022
Sedative_Hypnotic_Criteria_a11y.pdf

Open Download Copy Link 570.2 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
570.2 KBOctober 28, 2022
Sedative_Hypnotic_Criteria_a11y_PAC_UA_Report.pdf

Open Download Copy Link 271 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
271 KBOctober 28, 2022
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