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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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Abstral-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
1.42 MBOctober 28, 2022
Abstral-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
293.5 KBOctober 28, 2022
Adult_High_Dose_Antipsychotic_Form_a11y.pdf

Open Download Copy Link 970 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
970 KBOctober 28, 2022
Adult_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
285.53 KBOctober 28, 2022
Albumin_Form_a11y.pdf

Open Download Copy Link 1.48 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
1.48 MBOctober 28, 2022
Albumin_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
287.39 KBOctober 28, 2022
Antidepressants_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
1.81 MBOctober 28, 2022
Antidepressants_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
284.46 KBOctober 28, 2022
Antipsychotic_6Years_Form_a11y.pdf

Open Download Copy Link 1.85 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
1.85 MBOctober 28, 2022
Antipsychotic_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
300.01 KBOctober 28, 2022
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