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.
Use our Medicaid Preferred Drug List or Ambetter Preferred Drug List (PDF) to find more information on the drugs that are covered.
Preferred Drug List
Prior Authorization Forms:
- Prior Authorization Form – Non-Specialty Medication (PDF)
- Prior Authorization Form for Specialty Medication or Buy and Bill (PDF)
- Medication PA Criteria and Drug Specific Forms
- Compound over $300 Prior Authorization Request Form (PDF)
- Informed Consent For Psychotherapeutic Form (PDF)
- Hepatitis C Treatment Agreement (PDF)
- Antidepressant < 6 Years Prior Authorization Request Form (PDF)
- Antipsychotic (6 to < 18 Years of Age) Prior Authorization Request Form (PDF)
- Antipsychotic Less than 6 Years of Age Prior Authorization Request Form (PDF)
Additional Pharmacy Information:
- Request to Change Lock-In Pharmacies (PDF)
- MPDS Lock-In Referral Form (PDF)
- Over-the-Counter Health and Wellness Catalog (PDF)
- Medicaid Supplemental Preferred Drug List (PDF)
- Supplemental Preferred Diabetic Products (PDF)
Pharmacy Resources:
- MerckMedicus - View medical resources online, such as textbooks, journals and Specialty Pages
RSV/Synagis Season:
For Ambetter Pharmacy information, please visit our Ambetter website.
Prior Authorization Phone: (866) 399-0928
Prior Authorization Fax: (866) 399-0929
Prior Authorization Forms:
- Prior Authorization Form – Non-Specialty Medication (PDF)
- Prior Authorization Request Form for Specialty Medication or Buy and Bill (PDF)
- Compound over $300 Prior Authorization Request Form (PDF)
Additional Pharmacy Information:
Pharmacy Resources
- MerckMedicus
View medical resources online, such as textbooks, journals and Specialty Pages - MerckSource
Help your patients through resources such as Condition Guides and Health Centers.