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Your Medicaid prescription coverage

Managing your medicines is important. We want you to feel comfortable knowing what medicines your plan covers. Learn about your pharmacy benefits and more.

A doctor writes out a prescription at a pharmacy counter next to a girl sitting on the counter.

Find the medicines you need

Managing your medicines is important. We want you to feel comfortable knowing that your prescriptions will be covered by your plan. Learn about your Medicaid prescription benefits and more.

What drugs are covered?

As a Humana Healthy Horizons™ in Florida member, you can access a full range of safe and effective medicines. These medicines are part of a formulary, or Drug List, PDF opens new window. The medicines on the Drug List are available at no cost to you.

Your doctor will use the Drug List to choose the best medicine to treat you and your condition.

Some covered medicines may have extra steps you need to take or limits on what is covered. You may need to get approval (also known as prior authorization) for certain medicine.

We will cover your use of a medicine from the Drug List as long as there is a medical need for you to be on it. You also need to fill your prescription at a Humana network pharmacy and follow other plan rules.

Check Drug List (English, PDF opens new window and Spanish, PDF opens new window)

Prior authorizations

You may need to get approval before you can get a certain medicine (also known as prior authorization).

Whether a medicine needs this approval or not may change.

Check the Drug List to see which medicines need prior authorization.

Learn more about Humana Healthy Horizons in Florida Drug List criteria, opens in new window from the Agency for Health Care Administration.

How to get prior authorization

Only your doctor can send a prior authorization request for you. If you need prior authorization for a prescription, your doctor can contact Humana Clinical Pharmacy Review (HCPR):

  • By phone: 1-800-555-CLIN (2546) (TTY: 711), Monday – Friday, 8 a.m. – 6 p.m., local time
  • By fax or mail: Your doctor can visit our Provider Prior Authorization webpage to:
    • Complete the preauthorization form
    • Submit statement of medical necessity, specific patient medical information, or peer-reviewed literature related to the request (as needed)

After printing the preauthorization form, your doctor can send it to us by fax or in the mail.

Fax: 1-877-486-2621

Mailing address:

Humana Pharmacy Operations
P.O. Box 33008
Louisville, KY 40232-3008

Find a pharmacy

To fill a prescription, you can go to one of the many pharmacies that accepts Humana Healthy Horizons in Florida.

Not sure where to go? Find an in-network pharmacy near you using our Find a Pharmacy service.

If you use an out-of-network pharmacy for any reason, you will have to pay the full cost of your medicine.

Find a pharmacy

Specialty pharmacy

If you need medicine to treat a complex or long-lasting condition like cancer, HIV, or multiple sclerosis, for example, you may need to get your prescription filled at a specialty pharmacy. Medicines to treat complex or long-lasting conditions only may be available at certain locations.

Use our Find a Pharmacy service to find an in-network specialty pharmacy near you.

Find a pharmacy

Humana Specialty Pharmacy

You may be able to fill your specialty prescriptions at our Humana Specialty Pharmacy®. This pharmacy will fill and mail your specialty prescription to your house.

For more information, call:

Humana Specialty Pharmacy

1-800-486-2668 (TTY: 711)
Monday – Friday, 8 a.m. – 8 p.m., Eastern time
Saturday, 8 a.m. – 6 p.m., Eastern time

Over-the-counter health and wellness

Your pharmacy benefit lets you order certain over-the-counter (OTC) health and wellness items through the mail. These medicines will be sent by UPS or the U.S. Postal Service within 10–14 working days after the order is made. There is no charge to you for shipping.

You will get the generic versions of the OTC items you order. Generic medicine is the same as a brand-name medicine in:

  • Dosage
  • Effectiveness
  • How to take the medicine
  • How the medicine works
  • Quality
  • Safety
  • Stability
  • Strength

You have a $25/month allowance to spend on OTC health and wellness items.

You can find a full list of the OTC health and wellness items that you can get in the mail on the OTC order form below.

Be sure to ask your doctor before taking any OTC medicines or vitamins.

Combined Medicaid medical and Long-term care (LTC) OTC form

Over-the-Counter Order Form – English (1.19 MB), PDF opens new window

Over-the-Counter Order Form – Spanish (838 KB), PDF opens new window

If you have questions about this mail-order service, call:

PrescribeIT Rx

1-800-526-1490 (TTY: 711)

If you paid out of pocket

We hope you don’t have to pay for any medicines out of pocket. If you do, let us know by filling out a reimbursement claim form, and you may get a refund.

Fill in the form below to send a reimbursement claim.

Prescription Drug Claim Form for Member Reimbursement, PDF opens new window

Looking for help?

Contact Us

If you have questions, find the number you need to get help and support.

Find a doctor

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Documents & forms

Find the documents and forms you need, including your member handbook.