Skip to main content

Questions?

Just contact us. We’re here to help.

Medications your plan covers

Medications your plan covers

Prescription medications

 

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.

 

View your PDL

Understand your medication

 

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).

 

Pharmacy FAQs

 

OTC medications

 

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

 

$25 for OTC products

 

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

 

In person

 

You can fill your prescriptions at any pharmacy in our network. We can’t cover medications that you fill at other pharmacies.

Find a pharmacy near me

 

Mail service

 

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:  

Online

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.

By phone

Just call CVS Caremark® at 1-855-271-6603 (TTY: 1-800-231-4403). You can call 24 hours a day, 7 days a week. If you say it’s okay, they’ll call your provider to get a prescription. 

Specialty medications

Specialty medications

Some conditions that need specialty medications include:

 

  • Cancer
  • Hemophilia
  • 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. You can also get it delivered to your home or doctor’s office. Just call CVS Specialty® pharmacy at 1-800-237-2767 (TTY/TDD: 1-800-863-5488), Monday through Friday, 7:30 AM to 9:00 PM.

 

Here’s a list of specialty medications (PDF). Your provider may need to get prior authorization for some medications on this list. 

 

Informed consent

 

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.

Medication recalls

 

Need info about medication recalls? Just call the U.S. Food and Drug Administration (FDA) at 1-888-463-6332.

 

Medication recalls

 

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. 

Target is a trademark of Target Brands, Inc.

Also of interest: