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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Xiaflex_Criteria_a11y.pdf
application/pdfXiaflex_Criteria_a11y.pdf Open Download Copy Link 617.36 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
Xiaflex_Criteria_a11y_PAC_UA_Report.pdf
application/pdfXiaflex_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 248.34 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
Xifaxan_Criteria_a11y.pdf
application/pdfXifaxan_Criteria_a11y.pdf Open Download Copy Link 621.85 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
Xifaxan_Criteria_a11y_PAC_UA_Report.pdf
application/pdfXifaxan_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 262.44 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
Xolair_Criteria_a11y.pdf
application/pdfXolair_Criteria_a11y.pdf Open Download Copy Link 629.29 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
Xolair_Criteria_a11y_PAC_UA_Report.pdf
application/pdfXolair_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 271.72 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
Xopenex_Criteria_a11y.pdf
application/pdfXopenex_Criteria_a11y.pdf Open Download Copy Link 653.12 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
Xopenex_Criteria_a11y_PAC_UA_Report.pdf
application/pdfXopenex_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 265.53 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
Xyrem_Criteria_a11y.pdf
application/pdfXyrem_Criteria_a11y.pdf Open Download Copy Link 657.97 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
Xyrem_Criteria_a11y_PAC_UA_Report.pdf
application/pdfXyrem_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 272.08 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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