Pharmacy and prescription drugs

Drug coverage information

Your benefits include a wide range of prescription drugs. Clear Health Alliance also covers many over-the-counter (OTC) medicines.

Preferred Drug List (PDL)

We use the Florida Medicaid Preferred Drug List (PDL). The PDL is the list of drugs that your doctor will use when prescribing medicine. Your doctor can prescribe most of these medicines to you without getting preapproval, or an “OK,” from us. The PDL is updated frequently.

• Preferred Diabetic Supply Information

Don’t see it listed?

If you don’t see your medicine listed on the PDL, you may ask for an exception at submitmyexceptionreq@anthem.com. You’ll be asked to supply a reason why it should be covered, such as an allergic reaction to a drug, etc.

Supplemental Preferred Drug List

The Supplemental Preferred Drug List (PDL) includes drugs the Clear Health Alliance pharmacy benefit covers that are not listed on the Agency For Health Care Administration (AHCA) PDL and sometimes require preapproval or prior authorization (PA). The Pharmacy and Therapeutics Committee evaluates the supplemental PDL to promote the appropriate and cost-effective use of medications. The supplemental PDL includes these classes:
•    Spacing devices and holding chambers: A spacer, or holding chamber, is an attachment that may be used with your inhaler.
      The spacer holds the medicine in place so you can breathe it in easier.
•    Select vaccines the Centers for Disease Control and Prevention (CDC) recommends.
•    Select diabetic supplies such as:

• Continuous glucose monitors (CGM).
• Diabetic meters (Trividia Health True Metrix brand).
• Diabetic test strips and lancets (Trividia Health True Metrix brand). 
• Needles and syringes.
• Ketostix.

When available, all products listed are preferred as generic.
For medical injectables: Please talk to your doctor. They should refer to the Precertification Lookup Tool for coverage and PA requirements.

Extra over-the-counter (OTC) benefit

You get an extra $25 per family per month for over-the-counter (OTC) items. Learn more about this extra benefit.

Prior authorizations (preapprovals)

Some medicines need a preapproval, or an “OK,” from Clear Health Alliance before your doctor can prescribe them. The preapproval process helps us make sure that you’re taking medications safely and correctly.

Here are some reasons that preapproval may be needed:

• There is a generic or pharmacy alternative drug available
• The drug could be misused or abused
• There are other drugs that should be tried first
• The drug has a high side effect potential
• The drug is prescribed at a higher dosage than recommended
• There is additional information needed about your condition so we can match it to the FDA approval of the drug and/or studies of effectiveness

For medicines that need preapproval, your provider will need to call 1-877-577-9044.

Pharmacy forms

Prescription Drug Reimbursement Form

Florida Medicaid members do not pay copays for medications. Call Pharmacy Member Services at 1-833-235-2028 (TTY 711) before paying cash for a medication. If you had to pay for a medicine that is covered under your plan, you may submit a request for reimbursement form.

• Prescription Drug Reimbursement Form — English
• Prescription Drug Reimbursement Form — Spanish