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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Abstral-Actiq-Fentora-Lazanda-Onsolis-Subsys_Form_a11y.pdf
application/pdfAbstral-Actiq-Fentora-Lazanda-Onsolis-Subsys_Form_a11y.pdf Open Download Copy Link 1.42 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Abstral-Actiq-Fentora-Lazanda-Onsolis-Subsys_Form_a11y_PAC_UA_Report.pdf
application/pdfAbstral-Actiq-Fentora-Lazanda-Onsolis-Subsys_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 293.5 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Adult_High_Dose_Antipsychotic_Form_a11y.pdf
application/pdfAdult_High_Dose_Antipsychotic_Form_a11y.pdf Open Download Copy Link 970 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Adult_High_Dose_Antipsychotic_Form_a11y_PAC_UA_Report.pdf
application/pdfAdult_High_Dose_Antipsychotic_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 285.53 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Albumin_Form_a11y.pdf
application/pdfAlbumin_Form_a11y.pdf Open Download Copy Link 1.48 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Albumin_Form_a11y_PAC_UA_Report.pdf
application/pdfAlbumin_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 287.39 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Antidepressants_Under_6_Years_Form_a11y.pdf
application/pdfAntidepressants_Under_6_Years_Form_a11y.pdf Open Download Copy Link 1.81 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Antidepressants_Under_6_Years_Form_a11y_PAC_UA_Report.pdf
application/pdfAntidepressants_Under_6_Years_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 284.46 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Antipsychotic_6Years_Form_a11y.pdf
application/pdfAntipsychotic_6Years_Form_a11y.pdf Open Download Copy Link 1.85 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Antipsychotic_6Years_Form_a11y_PAC_UA_Report.pdf
application/pdfAntipsychotic_6Years_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 300.01 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Antipsychotic_Under18_Form_a11y.pdf
application/pdfAntipsychotic_Under18_Form_a11y.pdf Open Download Copy Link 2.39 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Antipsychotic_Under18_Form_a11y_PAC_UA_Report.pdf
application/pdfAntipsychotic_Under18_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 283.64 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cytogam_Form_a11y.pdf
application/pdfCytogam_Form_a11y.pdf Open Download Copy Link 1.45 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Cytogam_Form_a11y_PAC_UA_Report.pdf
application/pdfCytogam_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 292.56 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Exondys_Form_a11y.pdf
application/pdfExondys_Form_a11y.pdf Open Download Copy Link 1.42 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Exondys_Form_a11y_PAC_UA_Report.pdf
application/pdfExondys_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 291.92 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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FL_PA_Colony_Stimulating_Factors_Form_a11y.pdf
application/pdfFL_PA_Colony_Stimulating_Factors_Form_a11y.pdf Open Download Copy Link 1.43 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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FL_PA_Colony_Stimulating_Factors_Form_a11y_PAC_UA_Report.pdf
application/pdfFL_PA_Colony_Stimulating_Factors_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 309.19 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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FL_PA_Erythropoeisis_Stimulating_Agents_a11y.pdf
application/pdfFL_PA_Erythropoeisis_Stimulating_Agents_a11y.pdf Open Download Copy Link 1.39 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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FL_PA_Erythropoeisis_Stimulating_Agents_a11y_PAC_UA_Report.pdf
application/pdfFL_PA_Erythropoeisis_Stimulating_Agents_a11y_PAC_UA_Report.pdf Open Download Copy Link 311.85 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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FL_PA_Opioid_Form_a11y.pdf
application/pdfFL_PA_Opioid_Form_a11y.pdf Open Download Copy Link 1.36 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 267.94 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Fuzeon_Form_a11y.pdf
application/pdfFuzeon_Form_a11y.pdf Open Download Copy Link 1.47 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Fuzeon_Form_a11y_PAC_UA_Report.pdf
application/pdfFuzeon_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 301.08 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Hep_C_Agents_Form_a11y.pdf
application/pdfHep_C_Agents_Form_a11y.pdf Open Download Copy Link 2.28 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Hep_C_Agents_Form_a11y_PAC_UA_Report.pdf
application/pdfHep_C_Agents_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 277.96 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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HIV_Diagnosis_Verification_Form_a11y.pdf
application/pdfHIV_Diagnosis_Verification_Form_a11y.pdf Open Download Copy Link 1.78 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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HIV_Diagnosis_Verification_Form_a11y_PAC_UA_Report.pdf
application/pdfHIV_Diagnosis_Verification_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 299.44 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Human_Growth_Hormore_Form_a11y.pdf
application/pdfHuman_Growth_Hormore_Form_a11y.pdf Open Download Copy Link 1.67 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Human_Growth_Hormore_Form_a11y_PAC_UA_Report.pdf
application/pdfHuman_Growth_Hormore_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 280.69 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Increlex_Form_a11y.pdf
application/pdfIncrelex_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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Increlex_Form_a11y_PAC_UA_Report.pdf
application/pdfIncrelex_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 306.09 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Multi_Source_Brand_Drug_Form_a11y.pdf
application/pdfMulti_Source_Brand_Drug_Form_a11y.pdf Open Download Copy Link 984.34 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Multi_Source_Brand_Drug_Form_a11y_PAC_UA_Report.pdf
application/pdfMulti_Source_Brand_Drug_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 298.61 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Nitisinone_Form_a11y.pdf
application/pdfNitisinone_Form_a11y.pdf Open Download Copy Link 1.21 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Nitisinone_Form_a11y_PAC_UA_Report.pdf
application/pdfNitisinone_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 286.86 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 1.67 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 297.35 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 287.65 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Pharm_Misc_Form_a11y.pdf
application/pdfPharm_Misc_Form_a11y.pdf Open Download Copy Link 1.11 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Pharm_Misc_Form_a11y_PAC_UA_Report.pdf
application/pdfPharm_Misc_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 295.02 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 286.24 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Selzentry_Form_a11y.pdf
application/pdfSelzentry_Form_a11y.pdf Open Download Copy Link 1.34 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Selzentry_Form_a11y_PAC_UA_Report.pdf
application/pdfSelzentry_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 285.54 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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SEROSTIM_PA_Form_a11y_.pdf
application/pdfSEROSTIM_PA_Form_a11y_.pdf Open Download Copy Link 1.44 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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SEROSTIM_PA_Form_a11y__PAC_UA_Report.pdf
application/pdfSEROSTIM_PA_Form_a11y__PAC_UA_Report.pdf Open Download Copy Link 310.55 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Soma_Form_a11y.pdf
application/pdfSoma_Form_a11y.pdf Open Download Copy Link 973.47 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Soma_Form_a11y_PAC_UA_Report.pdf
application/pdfSoma_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 297.4 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Spinraza_Form_a11y.pdf
application/pdfSpinraza_Form_a11y.pdf Open Download Copy Link 1.6 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Spinraza_Form_a11y_PAC_UA_Report.pdf
application/pdfSpinraza_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 305.78 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Stimulant_Less_Than_6_Yrs_Form_a11y.pdf
application/pdfStimulant_Less_Than_6_Yrs_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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Stimulant_Less_Than_6_Yrs_Form_a11y_PAC_UA_Report.pdf
application/pdfStimulant_Less_Than_6_Yrs_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 314.86 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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SUPPRELIN_LA_FORM_a11y.pdf
application/pdfSUPPRELIN_LA_FORM_a11y.pdf Open Download Copy Link 1.42 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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SUPPRELIN_LA_FORM_a11y_PAC_UA_Report.pdf
application/pdfSUPPRELIN_LA_FORM_a11y_PAC_UA_Report.pdf Open Download Copy Link 282.57 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Synagis_All_Florida_Regions_Combined_Form_a11y.pdf
application/pdfSynagis_All_Florida_Regions_Combined_Form_a11y.pdf Open Download Copy Link 1.73 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Synagis_All_Florida_Regions_Combined_Form_a11y_PAC_UA_Report.pdf
application/pdfSynagis_All_Florida_Regions_Combined_Form_a11y_PAC_UA_Report.pdf Open Download Copy Link 294.31 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Synagis_Weight_a11y.pdf
application/pdfSynagis_Weight_a11y.pdf Open Download Copy Link 1.34 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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Synagis_Weight_a11y_PAC_UA_Report.pdf
application/pdfSynagis_Weight_a11y_PAC_UA_Report.pdf Open Download Copy Link 291.06 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 304.92 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022 |
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