Pharmacy Prior Authorization

Lighthouse Health Plan is committed to providing appropriate, high-quality, and cost-effective drug therapy to all Lighthouse members. Lighthouse covers a full range of prescription medicines and certain over-the-counter medicines with a written order from a Lighthouse Health Plan 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 and which require prior authorization, please review our Preferred Drug List or call the Lighthouse Pharmacy Services team at 1-844-716-5412.

Lighthouse Health Plan accepts the medication-specific pharmacy prior authorization forms published by the Agency for Health Care Administration at Pharmacy Prior Authorization Forms.  Medications without a specific prior authorization form may be submitted on the Miscellaneous Medication Prior Authorization / Exception Form. Links to the miscellaneous and drug-specific authorization forms are posted below.

Pharmacy prior authorization requests for Lighthouse Health Plan enrollees must be submitted directly to Lighthouse via:

  • Fax: 1-866-265-5511
  • Mail:
    Lighthouse Health Plan
    Attn: Pharmacy Prior Authorization
    700 E. Gregory Street
    Ste. 150
    Pensacola, FL 32502
Miscellaneous and Drug-Specific Authorization Forms

Abstral-Actiq-Fentora-Lazanda-Onsolis-Subsys Form

Adult High Dose Antipsychotic Form

Albumin Form

Antidepressants Under 6 Years Form

Antipsychotic Under 6 Years Form

Antipsychotic 6 to 18 Years Form

Buprenorphine Agents Form

Cytogam Form

Exondys Form

Florida Opioid Form

Fuzeon Form

Hep C Agents Form

HIV Diagnosis Verification Form

Human Growth Hormore Form

Increlex Form

Multi Source Brand Drug Form

Neupogen Leukine Neulasta Granix Zarxio Form

Nityr Form

Oral Oncology Agents Form

Orfadin Form

Oxycodone ER Oxycontin Form

Panretin Form

Pharm Misc Form

Procrit Aranesp Form

Proleukin Form

Selzentry Form


Soma Form

Spinraza Form

Stimulant Less Than 6 Yrs Form


Synagis All Florida Regions Combined Form

Synagis Weight

Vfend Form