Pharmacy Services

Children's Medical Services Health Plan (CMS Health Plan) covers prescription drugs detailed in the Florida Agency For Health Care Administration (AHCA) Medicaid Preferred Drug List (PDL).

The PDL is a list of covered medicines that we prefer you child’s doctor uses. Drugs the plan covers are on the PDL.

The doctor will use the PDL to choose the best medicine to treat your child. 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 child's doctor or pharmacist if you have any questions about medicines.

Always ask the doctor if a prescription is covered by Children’s Medical Services Health Plan. If not, then ask the doctor to change it to a medicine that is covered. This will help you get the prescription filled the first time you take it to the pharmacy.

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 network pharmacy.

Spacers for Inhalers – Children’s Medical Services (CMS) Health Plan

CMS covers select spacers/aerosol-holding chambers for members that will be covered through the pharmacy benefit. Members may receive one select spacer/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. They work the same. Sometimes, we may need to approve using a brand name drug before your child’s prescription is filled.

• Preferred Drug List
• Over-the-Counter Health and Wellness Catalog (PDF)
• Pharmacy Lock-in Change Form (PDF)

13 and Under Requirements:

Some drugs for children 13 and under require a consent form (PDF).

• A parent or legal guardian must complete and sign this form
• The parent or legal guardian should fill out a separate form for each prescribed drug:
  • Medicaid will no longer pay for these drugs without the signed form 
  • You and your child's doctor will need to provide a copy of the form to the pharmacy when required

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.