Pharmacy Services

Children's Medical Services Health Plan (CMS Health Plan) covers prescription drugs listed on the Florida Agency For Health Care Administration (AHCA) Medicaid Preferred Drug List (PDL). The PDL is a list of medicines your child’s doctor is encouraged to use. It is reviewed regularly by doctors and pharmacists to ensure it includes only the safest and most effective options.

Your child’s doctor will use the PDL to choose the best medicine for your child. If a prescribed medicine is not on the PDL, ask the doctor if it can be changed to one that is covered. This can help ensure your prescription is filled without delay. If you have questions about your child’s medicines, talk with your child’s doctor or pharmacist.

Dispensing Limits

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 network pharmacy.

Spacers for Inhalers

CMS 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.

Covered Services

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 child’s prescription is filled. For details on medications and services covered, please see below.

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

Have Questions?

Member Services can help answer any questions at 1-866-799-5321 (TTY 1-800-955-9770) Monday through Friday 8 a.m. to 8 p.m. Eastern. Your child's care manager can also help answer questions about services.