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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Vascepa_Criteria_a11y.pdf
application/pdfVascepa_Criteria_a11y.pdf Open Download Copy Link 551.66 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Vascepa_Criteria_a11y_PAC_UA_Report.pdf
application/pdfVascepa_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 241.57 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Vecamyl_Criteria_a11y.pdf
application/pdfVecamyl_Criteria_a11y.pdf Open Download Copy Link 671.92 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Vecamyl_Criteria_a11y_PAC_UA_Report.pdf
application/pdfVecamyl_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 242.69 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Veregen_Criteria_a11y.pdf
application/pdfVeregen_Criteria_a11y.pdf Open Download Copy Link 546.58 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Veregen_Criteria_a11y_PAC_UA_Report.pdf
application/pdfVeregen_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 228.83 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Verquvo_Criteria_a11y.pdf
application/pdfVerquvo_Criteria_a11y.pdf Open Download Copy Link 535.78 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Verquvo_Criteria_a11y_PAC_UA_Report.pdf
application/pdfVerquvo_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 243.51 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Vfend_Form_a11y.pdf
application/pdfVfend_Form_a11y.pdf Open Download Copy Link 1.56 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Vfend_Form_a11y_PAC_UA_Report.pdf
application/pdfVfend_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 304.55 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Vibativ_Criteria_a11y.pdf
application/pdfVibativ_Criteria_a11y.pdf Open Download Copy Link 547.34 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Vibativ_Criteria_a11y_PAC_UA_Report.pdf
application/pdfVibativ_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 225.14 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Viberzi_Criteria_a11y.pdf
application/pdfViberzi_Criteria_a11y.pdf Open Download Copy Link 535.29 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Viberzi_Criteria_a11y_PAC_UA_Report.pdf
application/pdfViberzi_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 239.75 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Victoza_Criteria_a11y.pdf
application/pdfVictoza_Criteria_a11y.pdf Open Download Copy Link 707.27 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Victoza_Criteria_a11y_PAC_UA_Report.pdf
application/pdfVictoza_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 234.67 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Viltepso_Criteria_a11y.pdf
application/pdfViltepso_Criteria_a11y.pdf Open Download Copy Link 532.96 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Viltepso_Criteria_a11y_PAC_UA_Report.pdf
application/pdfViltepso_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 267.09 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Vimizim_Criteria_a11y.pdf
application/pdfVimizim_Criteria_a11y.pdf Open Download Copy Link 557.86 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Vimizim_Criteria_a11y_PAC_UA_Report.pdf
application/pdfVimizim_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 238.78 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Voxzogo_Criteria_a11y.pdf
application/pdfVoxzogo_Criteria_a11y.pdf Open Download Copy Link 545.5 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Voxzogo_Criteria_a11y_PAC_UA_Report.pdf
application/pdfVoxzogo_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 255.8 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Vpriv_Criteria_a11y.pdf
application/pdfVpriv_Criteria_a11y.pdf Open Download Copy Link 580.51 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Vpriv_Criteria_a11y_PAC_UA_Report.pdf
application/pdfVpriv_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 220.15 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Vyepti_Criteria_a11y.pdf
application/pdfVyepti_Criteria_a11y.pdf Open Download Copy Link 529.34 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Vyepti_Criteria_a11y_PAC_UA_Report.pdf
application/pdfVyepti_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 233.17 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Vyondys_53_Criteria_a11y.pdf
application/pdfVyondys_53_Criteria_a11y.pdf Open Download Copy Link 501.72 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Vyondys_53_Criteria_a11y_PAC_UA_Report.pdf
application/pdfVyondys_53_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 265.49 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Vyvgart_Criteria_a11y.pdf
application/pdfVyvgart_Criteria_a11y.pdf Open Download Copy Link 500 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Vyvgart_Criteria_a11y_PAC_UA_Report.pdf
application/pdfVyvgart_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 232.99 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Wakix_Criteria_a11y.pdf
application/pdfWakix_Criteria_a11y.pdf Open Download Copy Link 556.32 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Wakix_Criteria_a11y_PAC_UA_Report.pdf
application/pdfWakix_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 258.93 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Welireg_Criteria_a11y.pdf
application/pdfWelireg_Criteria_a11y.pdf Open Download Copy Link 506.05 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Welireg_Criteria_a11y_PAC_UA_Report.pdf
application/pdfWelireg_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 233.05 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Xenazine_Criteria_a11y.pdf
application/pdfXenazine_Criteria_a11y.pdf Open Download Copy Link 439.12 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Xenazine_Criteria_a11y_PAC_UA_Report.pdf
application/pdfXenazine_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 221.26 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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XERMELO_Criteria_a11y.pdf
application/pdfXERMELO_Criteria_a11y.pdf Open Download Copy Link 639.14 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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XERMELO_Criteria_a11y_PAC_UA_Report.pdf
application/pdfXERMELO_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 237.5 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Xgeva_Criteria_a11y.pdf
application/pdfXgeva_Criteria_a11y.pdf Open Download Copy Link 620.2 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Xgeva_Criteria_a11y_PAC_UA_Report.pdf
application/pdfXgeva_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 242.02 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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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Xywav_Criteria_a11y.pdf
application/pdfXywav_Criteria_a11y.pdf Open Download Copy Link 640.89 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Xywav_Criteria_a11y_PAC_UA_Report.pdf
application/pdfXywav_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 272.06 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Yescarta_Criteria_a11y.pdf
application/pdfYescarta_Criteria_a11y.pdf Open Download Copy Link 473.66 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Yescarta_Criteria_a11y_PAC_UA_Report.pdf
application/pdfYescarta_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 239.63 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Zeposia_Criteria_a11y.pdf
application/pdfZeposia_Criteria_a11y.pdf Open Download Copy Link 505.66 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Zeposia_Criteria_a11y_PAC_UA_Report.pdf
application/pdfZeposia_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 257.34 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Zokinvy_Criteria_a11y.pdf
application/pdfZokinvy_Criteria_a11y.pdf Open Download Copy Link 514.41 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Zokinvy_Criteria_a11y_PAC_UA_Report.pdf
application/pdfZokinvy_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 236.58 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Zolgensma_Criteria_a11y.pdf
application/pdfZolgensma_Criteria_a11y.pdf Open Download Copy Link 570.35 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Zolgensma_Criteria_a11y_PAC_UA_Report.pdf
application/pdfZolgensma_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 270.18 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Zortress_Criteria_a11y.pdf
application/pdfZortress_Criteria_a11y.pdf Open Download Copy Link 478.38 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Zortress_Criteria_a11y_PAC_UA_Report.pdf
application/pdfZortress_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 239.63 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Zulresso_Criteria_a11y.pdf
application/pdfZulresso_Criteria_a11y.pdf Open Download Copy Link 841.02 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Zulresso_Criteria_a11y_PAC_UA_Report.pdf
application/pdfZulresso_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 270.84 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Zyprexa_Relprevv_Criteria_a11y.pdf
application/pdfZyprexa_Relprevv_Criteria_a11y.pdf Open Download Copy Link 711.32 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Zyprexa_Relprevv_Criteria_a11y_PAC_UA_Report.pdf
application/pdfZyprexa_Relprevv_Criteria_a11y_PAC_UA_Report.pdf Open Download Copy Link 267.78 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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