Pharmacy

Sunshine Health has a pharmacy program for eligible members. Your doctor, or specialist, may give you a prescription for medicine. You must get the prescription filled at a pharmacy that is part of the Sunshine Health pharmacy network.

The Preferred Drug List (PDL) is a list of covered medicines. Your doctor will use the PDL to choose the best medicine to treat you. This list is reviewed by doctors and pharmacists regularly to make sure only the safest and most effective drugs are on the list. Please ask your doctor or pharmacist if you have any questions about your medicines. Always ask the doctor if your prescription is covered by Sunshine Health. If not, then ask the doctor to change it to a medicine that is covered. This will help you get your prescription filled the first time you take it to the pharmacy.

We cover brand name and generic drugs. Generic drugs have the same ingredients as brand name drugs, but they are often cheaper than brand name drugs. They work the same. Sometimes, we may need to approve using a brand name drug before your prescription is filled.

Dispensing Limits

Medications may be dispensed up to a maximum of 34-day supply for each new prescription refill 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 – Medicaid/Long Term Care/Sunshine Health Pathway to Shine Specialty Plan

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

Covered Services

• Preferred Drug List
• Over-the-Counter Health and Wellness Catalog (PDF)