Pharmacy
Sunshine Health has a pharmacy program for eligible members. Your doctor, or specialist, may give you a prescription for medicine. You must get the prescription filled at a pharmacy that is part of the Sunshine Health pharmacy network.
The Preferred Drug List (PDL) is a list of covered medicines. Your doctor will use the PDL to choose the best medicine to treat you. This list is reviewed by doctors and pharmacists regularly to make sure only the safest and most effective drugs are on the list. Please ask your doctor or pharmacist if you have any questions about your medicines. Always ask the doctor if your prescription is covered by Sunshine Health. If not, then ask the doctor to change it to a medicine that is covered. This will help you get your prescription filled the first time you take it to the pharmacy.
We cover brand name and generic drugs. Generic drugs have the same ingredients as brand name drugs, but they are often cheaper than brand name drugs. They work the same. Sometimes, we may need to approve using a brand name drug before your prescription is filled.
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/Long Term Care/<Child Welfare>
Sunshine Health covers select spacers/aerosol-holding chambers for Medicaid members that will be covered through the pharmacy benefit. Members may receive one select spacer/chamber per year without prior authorization.
Covered Services
Get your prescriptions via mail-order
With this added benefit, you can have your medicines delivered to your home, at no cost. Sunshine Health offers pharmacy mail order through Express Scripts® Pharmacy. You can receive up to a 34-day supply on most medicines and up to a 100-day supply on some medicines (PDF). Some medicines are excluded (PDF).
How to Sign Up
- Ask your doctor to electronically send or fax a new prescription to Express Scripts. Your doctor can fax Express Scripts at 1-800-837-0959. This number is for provider fax use only.
- Register or sign in and have your member ID number ready. Follow the guided steps to request a prescription. Once Express Scripts has your information, they will contact your doctor for approval of your prescription.
- Call Express Scripts at 1-833-750-4300 (TTY 1- 800-899-2114). Express Scripts can contact your doctor for a new prescription to be filled at mail order.
- Mail a home delivery order form. To get a copy of the form, register or sign in. Go to the Benefit Menu, click Forms, and download the Home Delivery Order Form. Complete the form and mail it with your paper prescription to Express Scripts.
Shop for over-the-counter items
You can now order over-the counter health and wellness products through CVS. You can order by phone or in store. Download your OTC booklet (PDF).
Preferred Diabetic Supplies
Effective September 1, 2021, OneTouch® is the only preferred brand of diabetes testing supplies for Sunshine Health <Child Welfare Specialty Plan> members. If your child is using OneTouch® meters for the first time, OneTouch Verio® offers different meter options to meet your child’s health needs. To support a smooth transition to the OneTouch Verio® meter, LifeScan is providing our members with a new meter at no cost to them. Call 1-833-239-0650 or visit OneTouch.orderpoints.com.