Medicaid Supplemental Preferred Drug List
Sunshine Health is committed to providing appropriate, high quality, and cost effective care to our Sunshine Health members. Some products may require prior authorization (PA) or have limitations on maximum quantities. For the most current information about the Sunshine Health Pharmacy Program you may call Member Services at 1-866-796-0530 (TTY /TTD 1- 866-796-0524) or visit the Sunshine Health website www.SunshineStateHealth.com.
Supplemental Preferred Drug List
The Sunshine Health Supplemental Preferred Drug List (PDL) includes drugs covered through the Sunshine Health pharmacy benefit that are not listed on the AHCA Preferred Drug List. The Supplemental PDL is continually evaluated by the Sunshine Health Pharmacy and Therapeutics (P&T) Committee to promote the appropriate and cost-effective use of medications. The Committee is composed of the Sunshine Health Medical Director, Sunshine Health Pharmacy Director, and several Florida physicians and specialists.
Pharmacy Benefit Manager
Sunshine Health works with Envolve Pharmacy Solutions and CVS/Caremark to process all pharmacy claims for prescribed drugs. Some drugs on the Sunshine Health PDL require a PA and Envolve Pharmacy Solutions is responsible for administering this process. Envolve Pharmacy Solutions is our Pharmacy Benefit Manager.
Medications may be dispensed up to a maximum of 34 day supply for each new prescription or refill. A total of 80% of the days supply must have elapsed before the prescription can be refilled at a Sunshine Health network pharmacy.
- Sunshine Health Member Services: 1-866-796-0530; Fax: 1-866-714-7998
- Sunshine Health Member Services TTY/TDD: 1-866-796-0524
- Envolve Pharmacy Solutions Prior Authorizations: 1-866-399-0928; Fax: 1-866-399-0929
- Envolve Pharmacy Solutions Help Desk: 1-800-460-8988
Supplemental Preferred Drug List (PDL)
- Aerospan Inhalation Aerosol 8.9g (ages 5 and up) limit 1 per month
- Invanz IV – max of 1g/day
- Kyleena – limit 1 every 5 years
- Skyla – limit 1 every 3 years
- Mirena – limit 1 every 5 years
- Liletta – limit 1 every 5 years
- Methylphenidate HCl Cap SR 24HR 20 MG, 30 MG, 40 MG
- Paragard – limit 1 every 10 years
- Select Spacers / Aerosol-Holding Chambers limit 1 per year