Have an enrollment need? Shop our plans.
-
Our Health Plans
show Our Health Plans menu
-
- About Our Plans
- Our Benefits
- My Health Pays Rewards®
- Coverage Area Map
- Ways to Save
- What is Ambetter Health?
- Shop and Compare Plans
- Find a Doctor
Use your ZIP Code to find your personal plan.
- See coverage in your area
- Find doctors and hospitals
- View pharmacy program benefits
- View essential health benefits
Find and enroll in a plan that's right for you.
-
-
Join Ambetter Health
show Join Ambetter Health menu
-
- Four easy steps is all it takes
- What you need to enroll
- Special Enrollment Information
-
-
For Members
show For Members menu
-
- Pay Now
- Find a Doctor
- Drug Coverage
- Forms and Materials
- Ways to Pay
- New Members
- Renew Your Plan
- Better Health Center
- The Better Bulletin
- Member News
- Medicare Eligible
- Health Savings Account
Find everything you need in the member online account
- View your claims
- Review your plan benefits
- Print your ID card
- View rewards points total
-
Have an enrollment need? Shop our plans.
-
Our Health Plans
show Our Health Plans menu
-
- About Our Plans
- Our Benefits
- My Health Pays Rewards®
- Coverage Area Map
- Ways to Save
- What is Ambetter Health?
- Shop and Compare Plans
- Find a Doctor
Use your ZIP Code to find your personal plan.
- See coverage in your area
- Find doctors and hospitals
- View pharmacy program benefits
- View essential health benefits
Find and enroll in a plan that's right for you.
-
-
Join Ambetter Health
show Join Ambetter Health menu
-
- Four easy steps is all it takes
- What you need to enroll
- Special Enrollment Information
-
-
For Members
show For Members menu
-
- Pay Now
- Find a Doctor
- Drug Coverage
- Forms and Materials
- Ways to Pay
- New Members
- Renew Your Plan
- Better Health Center
- The Better Bulletin
- Member News
- Medicare Eligible
- Health Savings Account
Find everything you need in the member online account
- View your claims
- Review your plan benefits
- Print your ID card
- View rewards points total
-
Florida Pharmacy Resources for Providers | Ambetter from Sunshine Health
Pharmacy
We are committed to providing appropriate, high-quality, and cost-effective drug therapy to all Ambetter Health members. Use our Preferred Drug List to find more information on the drugs that Ambetter Health covers.
Prescription Drug Exception Request
The member, the member’s designee or the member’s prescribing physician may request an exception to Our Prescription Drug requirements when:
- The drug is not covered based on our formulary.
- We are discontinuing coverage of the drug.
- 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 the provider can utilize the regular PA request processes and forms available in our website. The provider should make sure to submit any information on previous approval of the drug for your patient or/and reason for requesting the exemption. A Medical Director, pharmacist, or other health care professionals who have appropriate clinical expertise in your patient’s condition will make a determination according to accepted medical practice. We will notify the member and the member’s prescribing physician of our decision within fifteen (15) calendar days or sooner, depending on the request.
If we do not approve the request, the member and the 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.