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Medications your plan covers
Medications your plan covers
Each plan has its own list of prescription medications we cover. This is known as the plan’s preferred drug list (PDL). We cover medications on this list if they are medically necessary. This means you need them to manage a health condition. Medicaid Managed Medical Assistance (MMA) members never have a copay. Florida Healthy Kids (FHK) members may have a $5 copay.
You can check your plan’s PDL. If your medication isn’t on this list, ask your provider to:
Prescribe a similar one that’s on the PDL
Get prior authorization (PA) for coverage
Need PA? Just ask your provider to complete PA. Or they can call Member Services.
All signed pharmacy PA request forms should be faxed to 1-855-799-2554.
Be sure to tell your providers about all the medications you take. This includes over-the counter medications, vitamins and supplements. Know what your medication is for and how to take it. Check out these medication tips. Or find answers to your questions in our pharmacy FAQ (Frequently Asked Questions).
Members under age 20 can get coverage for some OTC medications on the PDL. They just need to:
- Meet any added requirements (for some medications)
- Get a prescription from their provider
- Fill an OTC prescription at a pharmacy in our network
Are you a Medicaid member (age 20 and up)? If yes, you can get $25 per month (per household) toward some OTC medications and supplies. We’ll mail them directly to you. Just have your member ID number ready when you place your order:
Online: Just sign in with your member ID and password. Or create a new account if you’re a first-time visitor.
By phone: You can call OTC Health Solutions at 1-888-628-2770, Monday through Friday, 9 AM to 8 PM.
You can see the items eligible for this benefit in our OTC catalog (PDF).
Get medications and refills
Get medications and refills
If you need medication, your provider will write you a prescription for one on the PDL. You’ll want to:
- Ask your provider to make sure the medication is on the PDL
- Take your prescription to a pharmacy in our network
- Show your plan member ID card at the pharmacy
Need refills? Your medication label notes how many refills you have. Call your pharmacy to place a refill order well before you run out of medication. If your prescription is out of refills, check with your provider at least five days before you run out of medication. They may want to see you before adding refills.
Fill your prescriptions
You can fill your prescriptions at any pharmacy in our network. We can’t cover medications that you fill at other pharmacies.
Do you take medication regularly for a long-term condition (such as heart disease, diabetes or high cholesterol)? If yes, you may be able to get up to a 90-day supply by mail. Read on to learn more about starting mail service.
Get started with mail service
You can sign up for mail service:
Log in to your Member Portal. Go to “Tasks” and then “Pharmacy Services.” Go to Caremark.com by clicking on the “CVS” link. Then, choose “start mail service” to print the mail-order form.
Some conditions that need specialty medications include:
- Immune deficiency
- Multiple sclerosis
- Rheumatoid arthritis
Do you have a prescription for a specialty medication? If yes, then you can fill it at any CVS Pharmacy®, including those inside Target® stores or Publix Specialty Pharmacy.
CVS Specialty Pharmacy
Specialty drugs can be delivered to either your doctor's office or your home in temperature-controlled packaging with the necessary supplies (ex: needles, syringes, and alcohol wipes). Or, you can drop off and pick up your prescriptions at any CVS Pharmacy® location, including those inside Target stores.
Here’s a list of specialty medications (PDF). Your doctor may need to get prior authorization for some of the medications on this list.
Publix Specialty Pharmacy
You can call Publix Specialty Pharmacy at 1-855-797-8254, Monday through Friday, 8:30AM through 7PM. The initial prescription may be sent to your local Publix pharmacy and will be transferred to the specialty pharmacy as needed.
Here's a list of specialty medications. Your doctor may need to get prior authorization for some of the medications on this list.
More about Publix Specialty Pharmacy
Do you have a child under age 13 taking medication? If it’s a psychotropic medication, the pharmacy needs your approval first. Psychotropics are a type of medication that can affect the mind, emotions and behavior. To give your approval, your doctor can fill out a consent form for you to sign. Just take the signed form to the pharmacy for each new prescription.
Pharmacy access and rules
Your plan’s PDL is up to date with the medications we cover. Remember that some medications need PA before you can get them.
What is the Pharmacy Lock-in program?
This program helps to prevent potential abuse or misuse of benefits. Members choose one in-network pharmacy to fill their prescriptions. Then they stick with it this pharmacy for 12 months.
What happens if my pharmacy doesn’t have the medicine I need?
Just ask either your provider or your pharmacy to call the CVS Pharmacy help desk at 1-866-693-4445. They can approve the order at a new pharmacy for you.
What if I don’t want to use only one pharmacy?
You can file an appeal. To get started, just call Member Services. Or visit our grievances and appeals page. You have 60 days to file an appeal from the date on your letter about the lock-in program.
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