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Medicaid Pharmacy Program by Sunshine Health

Pharmacy Program

Sunshine Health is committed to providing appropriate, high quality, and cost-effective care to our 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 Provider Services at 1-844-477-8313 or visit Pharmacy and Provider News. 

Pharmacy Benefit Manager

Sunshine Health works with Express Scripts to process all pharmacy claims for prescribed drugs. Some drugs on the Sunshine Health PDL require a PA and Centene Pharmacy Services is responsible for administering this process. Express Scripts is our Pharmacy Benefit Manager.

Dispensing Limits

Medications may be dispensed up to a maximum of 34-day supply for each new prescription refill or 100-day supply for select medications. A total of 80% of the days’ supply must have elapsed before the prescription can be refilled at a Sunshine Health network pharmacy.

Spacers for Inhalers

Medicaid (MMA) / Long Term Care (LTC) / Sunshine Health Pathway to Shine Specialty Plan (CW) / Sunshine Health Mindful Pathways Specialty Plan (SMI) / Children’s Medical Services (CMS) Health Plan

Select spacers/aerosol-holding chambers for members are covered through the pharmacy benefit. Members may receive one select spacer/chamber per year without prior authorization.

Contact Information