Pharmacy and prescription drugs

Find a pharmacy

To find a pharmacy near you, use our pharmacy locator tool.

Find a pharmacy

Drug coverage information

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

Florida Medicaid members

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.

View the Preferred Drug List

• 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 Simply 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

As a Simply Medicaid member, you get an extra $25 per family per month for over-the-counter (OTC) items. Learn more about this extra benefit.

Florida Healthy Kids members

We have two drug lists that show which drugs are in your child’s plan.

Preferred Drug List (PDL)

The Preferred Drug List (PDL) is the list of drugs that your child’s doctor will use first when prescribing your child medicine. These drugs have been chosen for their quality and effectiveness. Your child’s doctor can prescribe most of these medicines without getting preapproval, or an “OK,” from us. The PDL is updated frequently.

• Preferred Drug List – English
• Preferred Drug List – Spanish

• Preferred Diabetic Supply Information (FHK)

You can also get many OTC medicines with a prescription from your doctor.

Don’t see it listed?

If you don’t see your child’s 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.

Searchable formulary

The formulary is a list of all brand-name and generic drugs available in your child’s plan. It lists all the drugs found on the PDL, plus others. All drugs on the formulary are covered, but many require preapproval before the prescription can be filled.

Find their medicine

Do you want to look up your child’s medicine and find out if it is covered in their plan? It’s easy when you use our search tool. This tool will help you learn about any limitations or restrictions for any particular drug.

You can search for a drug by:

• Typing the name (at least first three letters) of the drug in the search box
• Using the A-Z list to search by the first letter of the drug
• Clicking on the therapeutic class of the drug

Searchable Formulary

Extra over-the-counter (OTC) benefit

As a Simply member, your child gets an extra $10 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 Simply before your or your child’s 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 1-833-214-3607 (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