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Pharmacy Program

 

Florida Healthy Kids

Pharmacy Program

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by Florida Healthy Kids.

Click on the link below to view the Preferred Drug List.

Preferred Drug List (PDL) Search
Preferred Drug List (PDF 1.19 MB)

1/1/2018 PDL Update (PDF 165.54 KB)
10/1/2017 PDL Update (PDF 61.45 KB)
7/1/2017 PDL Update (PDF 135.7 KB)
4/1/2017 PDL Update (PDF 63.29 KB)
1/1/2017 PDL Update (PDF 178.72 KB) 


Step Therapy Program

Step Therapy (PDF 21.02 KB)

 

Drug Quantity Limits

Quantity Limits (PDF 20.11 KB)

 

Pharmacy Bulletins

Florida Healthy Kids Synagis Program (PDF 225.02 KB)
Florida Healthy Kids Synagis Enrollment Form (PDF 225.02 KB)
Florida Healthy Kids Synagis Program 5 Doses (PDF 51.26 KB)

 

Pharmacy Prior Authorization Guidelines

ICD-9 Diagnosis-Drug Match Policy and Diagnosis Code Table (PDF 168.64 KB)

 

Pharmacy Prior Authorization Forms 

Prior authorization is required for some services and medications. A current list of prior authorization services, medications and forms can be found below.


UnitedHealthcare Community Plan M*Plus (MMA)

Pharmacy Program 

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by UnitedHealthcare Community Plan M*Plus (MMA).

Click on the link below to view the Preferred Drug List.

View the Preferred Drug List (PDL)

6/1/2017 PDL Update (PDF 124.85 KB)
4/19/2017 PDL Update
(PDF 149.79 KB)
2/24/2017 PDL Update
(PDF 121.61 KB)
1/1/2016 PDL Update
(PDF 30.6 KB)

Prior Authorization Drug Criteria

 

 

Pharmacy Prior Authorization Forms 

Prior authorization is required for some services and medications. A current list of prior authorization services, medications and forms can be found below.


UnitedHealthcare Dual Complete® LP (HMO SNP)
H1045-040


UnitedHealthcare Dual Complete® LP (HMO SNP)
H1045-039


UnitedHealthcare Dual Complete®RP (Regional PPO SNP)
R7444-012


UnitedHealthcare Dual Complete®RP ONE (Regional PPO SNP)
R7444-013


UnitedHealthcare Health & Home Connection