Pharmacy and prescription drugs
We cover a wide range of prescription and over-the-counter (OTC) drugs. We work with CarelonRx to provide these pharmacy benefits. There are no copays when you fill your prescription at a plan pharmacy.
Find a pharmacy
To find a pharmacy near you, use our pharmacy locator tool.Find a pharmacy
Fill a prescription
Bring your member ID and prescription to a plan pharmacy. Your doctor can also call in the prescription for you.
It’s good to use the same pharmacy each time you fill a prescription. This way, your pharmacist will know about problems that may happen when you’re taking more than one prescription. If you use another pharmacy, you should tell the pharmacist about all medicines you’re taking.
Have your medicines mailed to you
We make getting prescriptions filled as convenient as possible. You can log in to your account and manage your prescriptions filled through home delivery. With your secure online account, you can:
- Order refills
- Track your shipments
- Get notifications
Medications straight to your doorstep
With the ZipDrug pharmacy program, you’ll get customized care at no extra cost. ZipDrug will connect you with a participating local pharmacy. The pharmacy will package your medications by time and day to help you understand what to take and when. They’ll also schedule free hand-delivery. You may even qualify for one-on-one support from the local pharmacy. They’ll create a personalized care plan to help manage your medications and health conditions.
Here’s how it works:
- Call to enroll at 844-947-3784 Monday through Friday, 9 a.m. to 5:30 p.m. Eastern time.
- Your prescriptions will be transferred by your participating local pharmacy. They’ll package your medications by time and day and set up refills so they’re on the same schedule.
- Receive your prescriptions by scheduled hand-delivery, at no extra cost. When your prescriptions are ready, the pharmacy will call you to schedule delivery for a day and time that’s most convenient
Prescription Drug Home Delivery Form
You can get many prescription drugs shipped directly to your home through CarelonRx Home Delivery. Use this form to set up home delivery on your prescription.
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.
Don’t see it listed?
If you don’t see your medicine listed on the PDL, you may ask for an exception at email@example.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) for members ages 0-20.
• Diabetic meters (Trividia Health True Metrix brand).
• Diabetic test strips and lancets (Trividia Health True Metrix brand).
• Needles and syringes.
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.
If you misplace your medicine or it is stolen, contact your provider. They will work with the pharmacy and Clear Health Alliance to review your case and replace the medicines as needed.
If you have any questions about your pharmacy benefit, call Pharmacy Member Services at 1-833-235-2028 (TTY 711), 24 hours a day, seven days a week.
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 Home Delivery Form
Get your specialty medications
We partner with CarelonRx Specialty Pharmacy and other pharmacies to meet all your specialty medication needs.Learn about specialty pharmacy