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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

  • Centene Pharmacy Solutions: 1-866-399-0928; Fax: 1-833-546-1507
  • Prior Authorizations: 1-866-399-0928; Fax: 1-833-546-1507
  • CMS Health Plan Prior Authorizations: 1-833-705-1351; Fax: 1-888-865-6531
  • Express Scripts Pharmacy Help Desk (MMA, LTC, CW and SMI members and pharmacists): 1-833-750-4392
  • Express Scripts Pharmacy Help Desk (CMS Health Plan members and pharmacists): 1-833-750-4401

Clinical Programs & Medication Adherence

Sunshine Health offers tailored clinical programs that are customized to drive medication adherence and reduce medication errors. These programs are designed to improve health outcomes by supporting members in managing chronic conditions and ensuring they receive the right medications at the right time to get and stay healthy.             

Specialty Pharmacy Services

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 / Sunshine Health Power to Thrive Specialty Plan (HIV)

Sunshine Health’s Preferred Specialty Pharmacy is AcariaHealth

AcariaHealth is a national specialty pharmacy dedicated to transforming lives through compassionate care. They focus on enhancing the health and outcomes of people with complex medical conditions. AcariaHealth takes a collaborative approach to care, working closely with providers to tailor treatment programs to meet members’ unique needs.

AcariaHealth provider services include:

  • Single point of contact (Provider Experience Managers)
  • Support with referral and prior authorization processes
  • Web-based collaboration and enhanced communication

While AcariaHealth is Sunshine Health’s preferred specialty pharmacy provider,  members have the option to request that prescriptions be filled by any willing in-network specialty pharmacy provider of their choosing.

How to Send a Prescription Referral

AcariaHealth

  • E-prescribe: Find AcariaHealth in your electronic medical records (EMR) system.
  • Phone: Dial 1-800-511-5144 Ext 608.0033 to speak directly to our pharmacists.
  • Fax: Send completed referral form via fax to 1-877-541-1503.
  • Download referral forms.

Contact AcariaHealth