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Pharmacy Prior Authorization

Miami Children's Health Plan is committed to providing appropriate, high-quality, and cost-effective drug therapy to all health plan members. Miami Children's Health Plan covers a full range of prescription medicines and certain over-the-counter medicines with a written order from a Miami Children's Health provider. Some prescription medicines have specific requirements and conditions that must be met before it can be received. This is called a prior authorization. To learn more about which prescription medicines are covered, please review our Prescription Drug List.

The Prescription Drug List will provide more information on the medicines that are covered, and which may require a prior authorization.

How to submit a request for a pharmacy prior authorization:
By Phone: Call the Provider Prior Authorization Request Line at 1-844-716-5413
By Fax:  Complete a request for prescription drug coverage
By Mail: Complete a request for prescription drug coverage and submit to:

   Miami Children's Health Plan
   5775 Blue Lagoon Dr, Suite 230
   Miami, FL 33126

Additional drug specific forms are available here:  

Drug Specific Prior Authorization forms

Medication Prior Authorization/Exception Form

Please have your provider fill out and fax these forms to 1-866-265-5511 when applicable.