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.

1
📁 Home → 📁 DC_Forms_8 ↓
Name
Vascepa_Criteria_a11y.pdf

Open Download Copy Link 551.66 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Vascepa_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
Vecamyl_Criteria_a11y.pdf

Open Download Copy Link 671.92 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Vecamyl_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
Veregen_Criteria_a11y.pdf

Open Download Copy Link 546.58 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Veregen_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
Verquvo_Criteria_a11y.pdf

Open Download Copy Link 535.78 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Verquvo_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
Vfend_Form_a11y.pdf

Open Download Copy Link 1.56 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Vfend_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
https://fcchealthplan.com/pharmacy-resources/?eeFolder=DC_Forms_8&ee=1&eeListID=1 0 6

Page: 1 of 7

10

c3a8f50857

QUICK LINKS

Find Providers
Pharmacy Resources
Health & Wellness
Member Resources
Member News
Helpful Links
Contact Us
FCC Member Services
1-833-FCC-PLAN
Translate »