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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
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
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
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
Albumin_Form_a11y.pdf

Open Download Copy Link 1.48 MB 2023-12-20 December 20, 2023 2022-10-28 October 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
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
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
Antipsychotic_6Years_Form_a11y.pdf

Open Download Copy Link 1.85 MB 2023-12-20 December 20, 2023 2022-10-28 October 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
Antipsychotic_Under18_Form_a11y.pdf

Open Download Copy Link 2.39 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Antipsychotic_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
Cytogam_Form_a11y.pdf

Open Download Copy Link 1.45 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Cytogam_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
Exondys_Form_a11y.pdf

Open Download Copy Link 1.42 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Exondys_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
FL_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
FL_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
FL_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
FL_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
FL_PA_Opioid_Form_a11y.pdf

Open Download Copy Link 1.36 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
FL_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
Fuzeon_Form_a11y.pdf

Open Download Copy Link 1.47 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Fuzeon_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
Hep_C_Agents_Form_a11y.pdf

Open Download Copy Link 2.28 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Hep_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
HIV_Diagnosis_Verification_Form_a11y.pdf

Open Download Copy Link 1.78 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
HIV_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
Human_Growth_Hormore_Form_a11y.pdf

Open Download Copy Link 1.67 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Human_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
Increlex_Form_a11y.pdf

Open Download Copy Link 1.69 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Increlex_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
Multi_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
Multi_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
Nitisinone_Form_a11y.pdf

Open Download Copy Link 1.21 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Nitisinone_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
Oral_Oncology_Agents_Form_a11y.pdf

Open Download Copy Link 1.67 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Oral_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
Panretin_Form_a11y.pdf

Open Download Copy Link 1.68 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Panretin_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
Pharm_Misc_Form_a11y.pdf

Open Download Copy Link 1.11 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Pharm_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
Proleukin_Form_a11y.pdf

Open Download Copy Link 1.69 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Proleukin_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
Selzentry_Form_a11y.pdf

Open Download Copy Link 1.34 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Selzentry_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
SEROSTIM_PA_Form_a11y_.pdf

Open Download Copy Link 1.44 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
SEROSTIM_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
Soma_Form_a11y.pdf

Open Download Copy Link 973.47 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Soma_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
Spinraza_Form_a11y.pdf

Open Download Copy Link 1.6 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Spinraza_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
Stimulant_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
Stimulant_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
SUPPRELIN_LA_FORM_a11y.pdf

Open Download Copy Link 1.42 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
SUPPRELIN_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
Synagis_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
Synagis_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
Synagis_Weight_a11y.pdf

Open Download Copy Link 1.34 MB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022
Synagis_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
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 304.92 KB 2023-12-20 December 20, 2023 2022-10-28 October 28, 2022

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