Pharmacy
Sunshine Health is committed to providing appropriate, high-quality, and cost-effective drug therapy to all Sunshine Health members. Sunshine Health covers prescription medications and certain over-the-counter medications with a written order from a Sunshine Health provider. The pharmacy program does not cover all medications. Some medications may require prior authorization and some may have limitations. Other medically necessary pharmacy services are covered as well.
Drug Lists
- Medicaid Preferred Drug List
- Medicaid Supplemental Preferred Drug List
- Supplemental Preferred Diabetic Products (PDF)
- Traditional Drugs – Therapeutic Interchange List (PDF)
- 100-Day Supply List (PDF)
General Pharmacy Forms
- Informed Consent For Psychotherapeutic Form (PDF)
- Lock-in Referral Form (PDF)
- Request to Change Lock-In Pharmacies (PDF)
Prior Authorization
- Drug Specific Prior Authorization Criteria
- Compound over $300 Prior Authorization Request Form (PDF)
- Prior Authorization Form – Non-Specialty Medication (PDF)
- Prior Authorization Form for Specialty Medication or Buy and Bill (PDF)
- Abstral/Actiq/Fentora/Lazanda/Onsolis/Subsys PA Form (PDF)
- Adult Antipsychotic High Dose PA Form (PDF)
- Albumin PA Form (PDF)
- Antidepressants Under 6 Years PA Form (PDF)
- Antipsychotic 6 to Under 18 Years PA Form (PDF)
- Antipsychotic Less than 6 years of age PA Form (PDF)
- Colony Stimulating Factors PA Form (PDF)
- Cytogam PA Form (PDF)
- Erythropoeisis Stimulating Agents PA Form (PDF)
- Exondys 51 PA Form (PDF)
- Fuzeon® PA Form (PDF)
- Hepatitis C Agents PA Form (PDF)
- HIV Diagnosis Verification PA Form (PDF)
- Human Growth Hormone PA Form (PDF)
- Increlex PA Form (PDF)
- Miscellaneous Form (PDF)
- Multi Source Brand Drug PA Form (PDF)
- Nitisinone PA Form (PDF)
- Opioid PA Form (PDF)
- Oral Oncology PA Form (PDF)
- Panretin PA Form (PDF)
- Proleukin PA Form (PDF)
- Selzentry PA Form (PDF)
- Serostim PA Form (PDF)
- Soma PA Form (PDF)
- Spinraza PA Form (PDF)
- Stimulants and Strattera (<6 years of age) PA Form (PDF)
- Supprelin LA PA Form (PDF)
- Synagis - All Florida Regions Combined PA Form (PDF)
- Synagis - Weight Change PA Form (PDF)
- Vfend PA Form (PDF)
Drug Lists
- Medicaid Preferred Drug List
- Medicaid Supplemental Preferred Drug List
- Supplemental Preferred Diabetic Products (PDF)
- Traditional Drugs – Therapeutic Interchange List (PDF)
- 100-Day Supply List (PDF)
General Pharmacy Forms
Prior Authorization
- Medication PA Criteria and Drug Specific Forms
- Compound over $300 Prior Authorization Request Form – CMS (PDF)
- Prior Authorization Form – Non-Specialty Medication – CMS (PDF)
- Prior Authorization Form for Specialty Medication or Buy and Bill – CMS (PDF)
- Abstral/Actiq/Fentora/Lazanda/Onsolis/Subsys PA Form – CMS (PDF)
- Adult Antipsychotic High Dose PA Form – CMS (PDF)
- Albumin PA Form – CMS (PDF)
- Antidepressants Under 6 Years PA Form – CMS (PDF)
- Antipsychotic 6 to Under 18 Years PA Form – CMS (PDF)
- Antipsychotic Less than 6 years of age PA Form – CMS (PDF)
- Colony Stimulating Factors PA Form – CMS (PDF)
- Cytogam PA Form – CMS (PDF)
- Erythropoeisis Stimulating Agents PA Form – CMS (PDF)
- Exondys 51 PA Form – CMS (PDF)
- Fuzeon® PA Form – CMS (PDF)
- Hepatitis C Agents PA Form – CMS (PDF)
- HIV Diagnosis Verification PA Form – CMS (PDF)
- Human Growth Hormone PA Form – CMS (PDF)
- Increlex PA Form – CMS (PDF)
- Miscellaneous Form (PDF)
- Multi Source Brand Drug PA Form – CMS (PDF)
- Nitisinone PA Form – CMS (PDF)
- Opioid PA Form – CMS (PDF)
- Oral Oncology PA Form – CMS (PDF)
- Panretin PA Form – CMS (PDF)
- Proleukin PA Form – CMS (PDF)
- Selzentry PA Form – CMS (PDF)
- Serostim PA Form – CMS (PDF)
- Soma PA Form – CMS (PDF)
- Spinraza PA Form – CMS (PDF)
- Stimulants and Strattera (<6 years of age) PA Form – CMS (PDF)
- Supprelin LA PA Form – CMS (PDF)
- Synagis - All Florida Regions Combined PA Form – CMS (PDF)
- Synagis - Weight Change PA Form – CMS (PDF)
- Vfend PA Form – CMS (PDF)
Preferred Drug List
Prior Authorization Forms
Additional Pharmacy Information
CVS Retail Pharmacies No Longer in network for 2022
Ambetter from Sunshine Health wants to make sure that our members receive the highest quality care at the lowest premium. One way we do this is by monitoring our pharmacy network performance.
To provide our members, your patients with the lowest possible premium for 2022, CVS retail pharmacies will no longer participate in our network as of January 1, 2022.
Additionally, Walgreens retail pharmacies will be the only in-network pharmacy for extended days’ supply prescriptions (those for 84 or more day supply). Members pay only 2.5 copays (save ½ a copay) when they fill eligible maintenance medications, 90 days at a time, at Walgreens starting January 1, 2022.
If your patients currently fill their prescriptions at CVS retail pharmacies, please send or call in their scripts to any in-network pharmacy. To help you locate an alternate in-network pharmacy for 2022, please refer to the Ambetter Health Guide Website.
We value having you as an Ambetter from Sunshine Health provider and we hope this information allows you to make informed decisions about managing your patient’s health.
Long Acting Injectable Antipsychotics (LAIAs) Administration Sites
Pharmacies with staff authorized to administer Long-Acting Injectable Antipsychotics (LAIAs) are available. Please contact the pharmacy for location-specific requirements.