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.
Sunshine Health follows the Agency for Health Care Administration (AHCA) Preferred Drug List (PDL) guidelines. Every quarter, the PDL is revised according to the recommendations of the AHCA Pharmaceutical and Therapeutics (P&T) Committee. Providers should always consult the most current PDL and quarterly changes.
Member Over-the-Counter Health and Wellness Catalogs
- OTC Health and Wellness Catalog - Medicaid/Comprehensive Long Term Care/Sunshine Health Mindful Pathways Specialty Plan (SMI)/Sunshine Health Power to Thrive Specialty Plan (HIV) (PDF)
- OTC Health and Wellness Catalog - Sunshine Health Pathway to Shine Specialty Plan (CW) (PDF)
- OTC Health and Wellness Catalog - Children's Medical Services Health Plan (PDF)
Drug Lists
- Medicaid Preferred Drug List
- Medicaid Supplemental Preferred Drug List
- Traditional Drugs – Therapeutic Interchange List (PDF)
- 100-Day Supply List (PDF)
General Pharmacy Forms
- Informed Consent For Psychotherapeutic Form (PDF)
- Lock-in Referral Form (PDF)
- Request to Change Lock-In Pharmacies (PDF)
Prior Authorization
- Cover My Meds electronic prior authorization (ePA)
- Drug Specific Prior Authorization Criteria
- Compound over $300 Prior Authorization Request Form (PDF)
- Prior Authorization Form – Non-Specialty Medication (PDF)
- Prior Authorization Form for Specialty Medication or Buy and Bill (PDF)
- Abstral/Actiq/Fentora/Lazanda/Onsolis/Subsys PA Form (PDF)
- Adult Antipsychotic High Dose PA Form (PDF)
- Albumin PA Form (PDF)
- Antidepressants Under 6 Years PA Form (PDF)
- Antipsychotic 6 to Under 18 Years PA Form (PDF)
- Antipsychotic Less than 6 years of age PA Form (PDF)
- Colony Stimulating Factors PA Form (PDF)
- Cytogam PA Form (PDF)
- Erythropoeisis Stimulating Agents PA Form (PDF)
- Exondys 51 PA Form (PDF)
- Fuzeon® PA Form (PDF)
- Hepatitis C Agents PA Form (PDF)
- HIV Diagnosis Verification PA Form (PDF)
- Human Growth Hormone PA Form (PDF)
- Increlex PA Form (PDF)
- Miscellaneous Form (PDF)
- Multi Source Brand Drug PA Form (PDF)
- Nitisinone PA Form (PDF)
- Opioid PA Form (PDF)
- Oral Oncology PA Form (PDF)
- Panretin PA Form (PDF)
- Proleukin PA Form (PDF)
- Selzentry PA Form (PDF)
- Serostim PA Form (PDF)
- Soma PA Form (PDF)
- Spinraza PA Form (PDF)
- Stimulants and Strattera (<6 years of age) PA Form (PDF)
- Supprelin LA PA Form (PDF)
- Synagis - All Florida Regions Combined PA Form (PDF)
- Synagis - Weight Change PA Form (PDF)
- Vfend PA Form (PDF)
Drug Lists
- Medicaid Preferred Drug List
- Medicaid Supplemental Preferred Drug List
- Traditional Drugs – Therapeutic Interchange List (PDF)
- 100-Day Supply List (PDF)
General Pharmacy Forms
Prior Authorization
- Cover My Meds electronic prior authorization (ePA)
- Medication PA Criteria and Drug Specific Forms
- Compound over $300 Prior Authorization Request Form – CMS (PDF)
- Prior Authorization Form – Non-Specialty Medication – CMS (PDF)
- Prior Authorization Form for Specialty Medication or Buy and Bill – CMS (PDF)
- Abstral/Actiq/Fentora/Lazanda/Onsolis/Subsys PA Form – CMS (PDF)
- Adult Antipsychotic High Dose PA Form – CMS (PDF)
- Albumin PA Form – CMS (PDF)
- Antidepressants Under 6 Years PA Form – CMS (PDF)
- Antipsychotic 6 to Under 18 Years PA Form – CMS (PDF)
- Antipsychotic Less than 6 years of age PA Form – CMS (PDF)
- Colony Stimulating Factors PA Form – CMS (PDF)
- Cytogam PA Form – CMS (PDF)
- Erythropoeisis Stimulating Agents PA Form – CMS (PDF)
- Exondys 51 PA Form – CMS (PDF)
- Fuzeon® PA Form – CMS (PDF)
- Hepatitis C Agents PA Form – CMS (PDF)
- HIV Diagnosis Verification PA Form – CMS (PDF)
- Human Growth Hormone PA Form – CMS (PDF)
- Increlex PA Form – CMS (PDF)
- Miscellaneous Form (PDF)
- Multi Source Brand Drug PA Form – CMS (PDF)
- Nitisinone PA Form – CMS (PDF)
- Opioid PA Form – CMS (PDF)
- Oral Oncology PA Form – CMS (PDF)
- Panretin PA Form – CMS (PDF)
- Proleukin PA Form – CMS (PDF)
- Selzentry PA Form – CMS (PDF)
- Serostim PA Form – CMS (PDF)
- Soma PA Form – CMS (PDF)
- Spinraza PA Form – CMS (PDF)
- Stimulants and Strattera (<6 years of age) PA Form – CMS (PDF)
- Supprelin LA PA Form – CMS (PDF)
- Synagis - All Florida Regions Combined PA Form – CMS (PDF)
- Synagis - Weight Change PA Form – CMS (PDF)
- Vfend PA Form – CMS (PDF)
Preferred Drug List
Prior Authorization Forms
Additional Pharmacy Information
Long Acting Injectable Antipsychotics (LAIAs) Administration Sites
Pharmacies with staff authorized to administer Long-Acting Injectable Antipsychotics (LAIAs) are available. Please contact the pharmacy for location-specific requirements.