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.
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)
- Medicaid Supplemental Preferred Drug List (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
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.
Get your prescriptions via mail-order
With this added benefit, you can have your child's medicines delivered to your home, at no cost. Sunshine Health offers pharmacy mail order through CVS Health. Your child can receive up to a 34-day supply on most medicines and up to a 100-day supply on some medicines (PDF). Some medicines are excluded (PDF).
How to Sign Up
- Call 1-888-624-1139. Have your child's member ID number ready when you call.
Preferred Diabetic Supplies
Effective September 1, 2021, OneTouch® is the only preferred brand of diabetes testing supplies for Children’s Medical Services Health Plan members. If your child is using OneTouch® meters for the first time, OneTouch Verio® offers different meter options to meet your child’s health needs. To support a smooth transition to the OneTouch Verio® meter, LifeScan is providing our members with a new meter at no cost to them. Call 1-833-239-0650 or visit OneTouch.orderpoints.com.