Florida Pharmacy Coverage | Ambetter from Sunshine Health

 

Pharmacy Resources

Ambetter takes our commitment to you seriously, and is honored to keep you covered during this unprecedented health situation.

For more details on COVID-19, Ambetter plan coverage, Telehealth, and prescription refills, please visit our FAQs page.

We are committed to providing appropriate, high-quality, and cost-effective drug therapy to all Ambetter members.

Save Money and Get Your Prescriptions Delivered to Your Door!

As an Ambetter member, you can maximize your pharmacy benefits by filling your prescriptions via either program below. Eligible members pay only 2.5x* their regular copay for a three-month fill.

CVS Mail Order

CVS Mail Order is the only in-network mail order pharmacy. Get your medications delivered to your home, or any other address you choose,
with no delivery fees. Prescription delivery may be right for you if you take
medications regularly for conditions like high blood pressure, arthritis or diabetes.

Two easy ways to get started:

1.  Call your doctor and ask them to send a new 90-day prescription to CVS Caremark Mail Service Pharmacy.

2.  Or, request a new 90-day prescription at Caremark.com.

AcariaHealth

Need a specialty pharmacy for your complex or chronic conditions? Prescription home delivery is available to you.

Get your specialty medications mailed directly to your door, free of charge. AcariaHealth offers specialty prescription delivery services for those living with complex conditions or chronic illnesses, such as rheumatoid arthritis, multiple sclerosis, hepatitis C or cancer. AcariaHealth’s licensed pharmacists are also available to you 24/7 to discuss prescribed therapy and answer any questions regarding medications and supplies.

AcariaHealth will work with your current specialty pharmacy provider to seamlessly transition your medications safely and efficiently. To get started, contact us at 1-800-511-5144.

Hemophilia Network

Please refer to the link below for a comprehensive listing of Ambetter’s in-network hemophilia pharmacies.

Prescription Drug Exception Request

You, your designee or your prescribing physician may request an exception to Our Prescription Drug requirements when:

  1. The drug is not covered based on our formulary.
  2. We are discontinuing coverage of the drug.
  3. The drug, as requested, does not conform to the limitations and procedures under Our drug utilization management program such as step therapy, dosage limitations or therapeutic substitutions.

To request this exception your provider can utilize the regular PA request processes and forms available in our website. Your provider should make sure to submit any information on previous approval of the drug for you or/and reason for requesting the exemption. A Medical Director, pharmacist, or other health care professionals who have appropriate clinical expertise in your condition will make a determination according to accepted medical practice. We will notify you and your prescribing physician of our decision within fifteen (15) calendar days or sooner, depending on the request. 

If we do not approve your request, you and your prescribing physician will receive detailed information about why the decision was made, as well as the process and time frame you should follow for submitting appeals.