Pharmacy Prior Authorizations

Vivida Health Plan is committed to providing appropriate, high-quality, and cost-effective drug therapy to all health plan members. Vivida Health Plan covers a full range of prescription medicines and certain over-the-counter medicines with a written order from a Vivida 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 1-844-716-5385
By Fax: Complete a request for prescription drug coverage
By Mail: Complete a request for prescription drug coverage and submit to:

Vivida Health Plan
6630 Orion Dr.
Suite 203
Fort Myers, FL 33912

Additional drug specific forms are available here:  

Drug Specific Prior Authorization forms []

Medication Prior Authorization/Exception Form Vivida PA form

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