Florida Medicaid Prescription Coverage, Pharmacy Benefits (2024)

As a Humana Healthy Horizons^® in Florida member, you can access a full range of safe and effective medicines. These medicines are part of a formulary, or Preferred Drug List, PDF opens new window. The medicines on the Preferred Drug List are available at no cost to you.

Your doctor will use the Preferred Drug List to choose the best medicine to treat you and your condition.

Some covered medicines may have extra steps you need to take or limits on what is covered. You may need to get approval (also known as prior authorization) for certain medicine.

We will cover your use of a medicine from the Preferred Drug Listas long as there is a medical need for you to be on it. You also need to fill your prescription at a Humana network pharmacy and follow other plan rules.

Check Preferred Drug List English, PDF opens new window andSpanish, PDF opens new window

The Agency for Health Care Administration (AHCA) also makes this information available. The AHCA Preferred Drug List includes the same information as our Preferred Drug List, including when items in the Preferred Drug List change. Review the AHCA Preferred Drug List, opens in new window.

You may need to get approval before you can get a certain medicine (also known as prior authorization).

Whether a medicine needs this approval or not may change.

Check the Preferred Drug List to see which medicines need prior authorization.

Learn more about Humana Healthy Horizons in Florida drug list criteria, opens in new window from the Agency for Health Care Administration.

How to get prior authorization

Only your doctor can send a prior authorization request for you. If you need prior authorization for a prescription, your doctor can contact Humana Clinical Pharmacy Review (HCPR):

• By phone: 800-555-CLIN (2546) (TTY: 711), Monday – Friday, 8 a.m. – 6 p.m., local time
• By fax or mail: Your doctor can visit our Provider Prior Authorization webpage to:
  • Complete the preauthorization form
  • Submit statement of medical necessity, specific patient medical information, or peer-reviewed literature related to the request (as needed)

After printing the preauthorization form, your doctor can send it to us by fax or in the mail.

Fax: 877-486-2621

Mailing address:

Humana Pharmacy Operations
P.O. Box 14601
Lexington, KY 40512

To fill a prescription, you can go to one of the many pharmacies that accepts Humana Healthy Horizons in Florida.

Not sure where to go? Find an in-network pharmacy near you using our Find a Pharmacy service.

If you use an out-of-network pharmacy for any reason, you will have to pay the full cost of your medicine.

Find a pharmacy

On June 11, 2022, Humana Pharmacy^® and Humana Specialty Pharmacy^® became CenterWell Pharmacy™ and CenterWell Specialty Pharmacy™, respectively. PrescribeIT Rx Pharmacy also became CenterWell Pharmacy. Our new name reflects our commitment to putting you at the center of everything we do. Best of all, there’s nothing for you to do.

You’ll continue getting your medication on time as you did before. We’ll also let your doctors know.

To learn more about CenterWell Specialty Pharmacy

• Call 800-486-2668 (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m., and Saturday, 8 a.m. to 6 p.m., Eastern time
• Visit CenterWell Specialty Pharmacy online

To learn more about CenterWell Pharmacy, formerly PrescribeIT Rx:

• Call 800-526-1490 (TTY: 711), Monday – Friday, 8 a.m. – 6 p.m., Eastern time

If you need medicine to treat a complex or long-lasting condition like cancer, HIV, or multiple sclerosis, for example, you may need to get your prescription filled at a specialty pharmacy. Medicines to treat complex or long-lasting conditions only may be available at certain locations.

Use our Find a Pharmacy service to find an in-network specialty pharmacy near you.

Find a pharmacy

CenterWell Specialty Pharmacy

You may be able to fill your specialty prescriptions at our CenterWell Specialty Pharmacy. This pharmacy will fill and mail your specialty prescription to your house.

For more information, call:

CenterWell Specialty Pharmacy

Call 844-486-2668 (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m., and Saturday, 8 a.m. to 6 p.m., Eastern time

Your pharmacy benefit lets you order certain over-the-counter (OTC) health and wellness items through the mail. These medicines will be sent by UPS or the U.S. Postal Service within 10–14 working days after the order is made. There is no charge to you for shipping.

You will get the generic versions of the OTC items you order. Generic medicine is the same as a brand-name medicine in:

• Dosage
• Effectiveness
• How to take the medicine
• How the medicine works
• Quality
• Safety
• Stability
• Strength

You have a $25 per month allowance to spend on OTC health and wellness items.

You can find a full list of the OTC health and wellness items that you can get in the mail on the OTC order form below.

Be sure to ask your doctor before taking any OTC medicines or vitamins.

Combined Medicaid medical and Long-term care (LTC) OTC form

Over-the-Counter Order Form – English (1.19 MB), PDF opens new window

Over-the-Counter Order Form – English/Spanish (838 KB), PDF opens new window

If you have questions about this mail-order service, call:

CenterWell Pharmacy

800-526-1490 (TTY: 711), Monday – Friday, 8 a.m. – 6 p.m., Eastern time

We hope you don’t have to pay for any medicines out of pocket. If you do, let us know by filling out a reimbursem*nt claim form, and you may get a refund.

Fill out the form below to send a reimbursem*nt claim.

Prescription Drug Claim Form for Member Reimbursem*nt, PDF opens new window

Humana Healthy Horizons in Florida

• Pharmacy