We cover a wide range of prescription and over-the-counter (OTC) drugs. We work with CarelonRx to provide these pharmacy benefits.
Find a pharmacy
To find a pharmacy near you, use our pharmacy locator tool.
Find a pharmacy
Fill a prescription
Bring your or your child’s member ID and prescription to a plan pharmacy. A 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 or your child are taking.
Your costs
Copays are a set dollar amount you pay for a covered service, like getting a prescription filled.
Florida Medicaid members
There are no copays for covered prescriptions.
Florida Healthy Kids members
There is a $5 copay for covered prescriptions.
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.
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 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
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.
Need help?
If you misplace your or your child’s medicine or it is stolen, contact your provider. They will work with the pharmacy and Simply to review your case and replace the medicines as needed.
If you have any questions about your or your child’s pharmacy benefit, call Pharmacy Member Services at 1-833-214-3607 (TTY 711) for Florida Medicaid or 1-833-267-3110 (TTY 711) for Florida Healthy Kids, 24 hours a day, 7 days a week.
Pharmacy forms
Prescription Drug Reimbursem*nt 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 reimbursem*nt form.
- Prescription Drug Reimbursem*nt Form — English
- Prescription Drug Reimbursem*nt Form — Spanish
