Florida Pharmacy Coverage | Ambetter from Sunshine Health

 

Pharmacy Resources

We are committed to providing appropriate, high-quality, and cost-effective drug therapy to all Ambetter Health members.

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Save Money and Get Your Prescriptions Delivered to Your Door!

Prescription Delivery

As an Ambetter from Sunshine Health member, you can maximize your pharmacy benefits by filling your prescriptions by mail. Eligible members may save when ordering a 90-day supply*. Delivery is free and can be to your home, workplace or any address you choose.  

Prescription delivery may be right for you if you take medications regularly for conditions like high blood pressure, arthritis or  diabetes.  

Two easy ways to get started:  

  1. Call your provider and ask them to send a new 90-day prescription to Express Scripts® Pharmacy. 
  2. Or request prescription delivery in your online member account.  

*Members may save when they fill eligible medications, 90 days at a time, through Express Scripts® Pharmacy. 

AcariaHealth

Looking for a specialty pharmacy to help navigate your complex or chronic condition? AcariaHealth is here to support you along your health care journey

Get your specialty medications mailed directly to your door. AcariaHealth offers convenient specialty prescription delivery services for those living with complex conditions or chronic illnesses, such as rheumatoid arthritis, multiple sclerosis, hepatitis C, or cancer. AcariaHealth’s licensed pharmacists are also available to you 24/7 to discuss prescribed therapy and answer any questions regarding medications and supplies. Their team will work with your current specialty pharmacy provider to ensure a safe and seamless transition of your medications.

Learn more about how AcariaHealth can support you with your complex or chronic condition.

Hemophilia Network

Please refer to the link below for a comprehensive listing of Ambetter Health’s in-network hemophilia pharmacies.

Prescription Drug Exception Request

You, your designee or your prescribing physician may request an exception to Our Prescription Drug requirements when:

  1. The drug is not covered based on our formulary.
  2. We are discontinuing coverage of the drug.
  3. 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 your provider can utilize the regular PA request processes and forms available in our website. Your provider should make sure to submit any information on previous approval of the drug for you or/and reason for requesting the exemption. A Medical Director, pharmacist, or other health care professionals who have appropriate clinical expertise in your condition will make a determination according to accepted medical practice. We will notify you and your prescribing physician of our decision within fifteen (15) calendar days or sooner, depending on the request. 

If we do not approve your request, you and your 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.