Pharmacy benefits CY19

Pharmacy benefits CY19

Prescription drugs

Magellan Complete Care of Florida (MCC of FL) covers most drugs. This includes injections. Drugs on the Preferred Drug List (PDL) do not need authorization. Your doctor has to authorize drugs that are not on the list.

Drug exceptions

If your doctor feels that you need a medicine that is not on the list of drugs we will pay for, you may request a Drug Exception. Some reasons for an exception are:

  • You are allergic to the other drug options on the list
  • You tried the approved drug(s) and they did not work
  • You cannot take the approved drug

If you have any questions please call us at 1-800-327-8613 (TTY 711) or you may have your doctor call us at 1-800-327-8613 to ask for an exception.

Specialty medications

MCC of FL works with Magellan Rx Specialty pharmacy to make it easy for you to quickly get your specialty medicine. These medicines often need special storage or handling.

This specialty pharmacy will help you by providing written information about your condition and medicine. You get free delivery of your medicine to your home or another address. Nurses are there to answer your questions. 

You can call the specialty pharmacy at 1-866-554-2673 (TTY 711). If you do not want to use Magellan Rx Specialty pharmacy, you can and let them know.

Over-the-counter medication supplies

  • You can get your over the counter medicines and supplies as part of your benefits
  • All covered over-the-counter items are either:
    • A medicine
    • An ointment or spray
    • Used for treatment of a condition with active medical ingredients
  • Covered first aid supplies include:
    • Bandages
    • Dressings
    • Non-sport tapes 

About the program:

  • Your benefit is $25 per month 
  • Your over-the-counter funds do not carry over to the next month
  • Your order total cannot go over your benefit amount
  • We cannot accept payment if you want to buy items once you have used your monthly benefit

You can order three ways:

  • Order online
  • Order by mail
    • Clearly write your name, address, telephone number and member ID number in the space at the top of the form.
    • Enter the amount of items that you want on the order form. The total must add up to your benefit amount or less.
    • Fold this form and put it in an envelope. Place a first class postage stamp on the envelope and send it to:
      • OTC Health Solutions
        9675 NW 117th Avenue, Suite 202
        Miami, FL 33178
  • Order by phone
    • To place your order by phone, call 1-888-628-2770 (TTY 711)
      • 9:00 am to 5:00 pm Eastern Time, Monday through Friday.

When an item is covered by Part B or Part D because of a special condition, you would not use your over-the-counter benefit to get the item. This item is instead covered by Medicare. When this happens, your over-the-counter benefit amount will not be affected for the Medicare covered item.