Pharmacy Information and Tools
Simply will administer pharmacy benefits for enrolled members. CarelonRx is the pharmacy benefits manager.
Medicaid
Please refer to the Preferred Drug List (PDL) when prescribing for our members. This guide does not contain a complete list of drugs; rather, it lists the preferred drugs within the most commonly prescribed therapeutic categories.
Though most medications on the PDL are covered without precertification, a few agents will require you to contact our Pharmacy Department for authorization.
Precertifications by phone:
You can reach our Pharmacy Department at 1-877-577-9044 between 8:00 a.m. and 8:00 p.m. Eastern time Monday through Friday.
Precertifications by fax:
You can also fax your request to our Pharmacy Department:
Retail Prior Authorization - 1-877-577-9045
Medical Injectables - 1-844-509-9862
Florida Healthy Kids
Medicare
Please refer to the formularies when prescribing for Medicare members. Though most medications on the formulary are covered without prior authorization, a few agents will require you to obtain an authorization. For Medicare Part B, contact Provider Services at 1-866-805-4589, option 5, Monday through Friday, 8 a.m. to 8 p.m. ET. For Medicare Part D, contact Pharmacy Services at 1-877-577-9044, Monday through Friday, 8 a.m. to 8 p.m. ET.
Medicare Part D Rx Coverage Determinations and Appeals
Providers may send a request for a prescription coverage determination for a Medicare plan via phone, fax or email:
- Phone: 1-877-577-9044
- Fax: 1-877-577-9045
- Email: RxAuth@simplyhealthcareplans.com