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.
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)
- Supplemental Preferred Diabetic Products (PDF)
RSV/Synagis Season
Preferred Drug List
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 guide.ambetterhealth.com.
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.
Additional Pharmacy Information
Prior Authorization Forms
- Exondys (PDF)
- Antidepressants Under 6 Years (PDF)
- Antipsychotic < 6 Years (PDF)
- Antipsychotic 6 to < 18 Years (PDF)
- Buprenorphine Agents for Opioid Dependence (PDF)
- Hepatitis C Agents (PDF)
- Informed Consent For Psychotherapeutic Form (PDF)
- Erythropoiesis Stimulating Agents (PDF)
- Colony Stimulating Factors (PDF)
- Opioid Agents (PDF)
- Oral Oncology Agents (PDF)
- Spinraza (PDF)
- Supprelin LA (PDF)
- Synagis® – All Florida Regions Combined (PDF)
- Synagis® Weight Change (PDF)
Provider Educational Resources
Envolve Pharmacy Solutions provides quarterly educational outreach material to providers on common drug therapy and disease problems with the aim of improving prescribing and dispensing practices.