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Stay Connected on the Go! Download our Health Insurance Portal mobile app to search for care, view benefits and access your Member ID card. LEARN MORE AND DOWNLOAD THE APP

Pharmacy

Sunshine Health offers a pharmacy program for eligible members. Your doctor or specialist may give you a prescription for medicine. You must fill your prescription at a pharmacy that is part of the Sunshine Health pharmacy network.

Preferred Drug List (PDL)

The Preferred Drug List (PDL) is a list of covered medicines. Your doctor uses this list to choose the best medicine for your treatment. The PDL is reviewed regularly by doctors and pharmacists to make sure it contains only the safest and most effective drugs.

  • Ask your doctor or pharmacist if you have questions about your medicines.
  • Confirm with your doctor that your prescription is covered by Sunshine Health. If not, ask for a covered alternative to avoid delays.
  • We cover brand-name and generic drugs. Generic drugs have the same active ingredients as brand names and work the same way, but often cost less.
  • In some cases, prior approval may be needed before you can receive a brand-name drug.

Dispensing Limits for Comprehensive Long Term Care Members

New prescriptions or refill medications may be dispensed up to a maximum 34-day supply or 100-day supply for select medications. A total of 80% of the days’ supply must have elapsed before the prescription can be refilled at a Sunshine Health network pharmacy.

Spacers for Inhalers for Comprehensive Long Term Care Members

Sunshine Health covers select spacers/aerosol-holding chambers for Medicaid members through the pharmacy benefit. Members may receive one select spacer or chamber per year without prior authorization.

Prescription Delivery

If you live in a nursing facility, Sunshine Health will arrange delivery of your new and refill prescriptions from the pharmacy. Facility staff will assist you with taking your medications, ordering refills, and answering any questions you may have about your prescriptions.

Covered Services

Get your prescriptions via mail-order

With this added benefit, you can have your medicines delivered to your home, at no cost. Sunshine Health offers pharmacy mail order through Express Scripts® Pharmacy.  Some medicines are excluded. For details, contact Express Scripts at 1-833-750-4300 (TTY 1- 800-899-2114). You can receive up to a 34-day supply on most medicine and up to a 100-day supply on some medicines (PDF). Some medicines are excluded.

How to Sign Up

  • Ask your doctor to electronically send or fax a new prescription to Express Scripts. Your doctor can fax Express Scripts at 1-800-837-0959. This number is for provider fax use only.
  • Register or sign in and have your member ID number ready. Follow the guided steps to request a prescription. Once Express Scripts has your information, they will contact your doctor for approval of your prescription.
  • Call Express Scripts at 1-833-750-4300 (TTY 1- 800-899-2114). Express Scripts can contact your doctor for a new prescription to be filled at mail order.
  • Mail a home delivery order form. To get a copy of the form, register or log in. Go to the Benefit Menu, click Forms, and download the Home Delivery Order Form. Complete the form and mail it with your paper prescription to Express Scripts.

Shop for over-the-counter items

You can now order your over-the counter health and wellness products through CVS. You can order online, by phone or in store.

Specialty Pharmacy Services

What is a Specialty Medication?

A specialty drug is a prescription drug that needs special handling, administration or monitoring. These are usually only ordered through a specialty pharmacy.

What is a Specialty Pharmacy?

A specialty pharmacy provides services and medications for members with chronic, complex or rare conditions. The services are done by highly trained professionals and are usually more extensive than regular retail pharmacies. Specialty pharmacy services can include clinical help, such as training on how to take medication.

Your Preferred Specialty Pharmacy is AcariaHealth.

AcariaHealth is a national specialty pharmacy. They focus on enhancing the health and outcomes of people with complex medical conditions. AcariaHealth works closely with you and your doctors to tailor treatment programs to meet your unique needs.

Contact AcariaHealth:

While AcariaHealth is your preferred specialty pharmacy provider, you can  request that prescriptions be filled by any willing in-network specialty pharmacy provider.

Fill and Receive Your Prescriptions

To find a pharmacy near you, use our Find a Provider Tool.