Molinalogo

What’s covered

Prescription drugs

Prescriptions are provided at no cost to you when they are filled at approved pharmacies.

Some drugs ordered by your doctor may require prior approval.

Covered prescriptions and over-the-counter drugs are listed on the drug list.

Prior approval drugs are in gray on the drug list. Sometimes you may experience small delays in getting your prescriptions filled. This is because we have requested additional information from your doctor - which we need to approve your medication. Your doctor may request a prescription drug prior approval by faxing a prior authorization form to (888) 373-3059. Please remind your doctor when your medication requires a prior approval. If a drug does not appear in the drug list, your doctor may request a review by the Molina Pharmacy team, by faxing a prior authorization form to (888) 373-3059.

Getting an exception to the formulary

Drugs not listed on the formulary are called non‐formulary drugs. For non‐formulary drugs, you have the following options:

• You can ask your physician to order a similar drug that is listed in the formulary.
• You can ask your physician to request an exception so your non‐formulary drug can be covered by your benefit.
• You can start the request for exception for a non‐formulary drug.
• If you want to start the exception process, you can call Member Services.

Drug List (Formulary)

Molina Healthcare, along with all MI Medicaid Health Plans, utilizes the Michigan Common Formulary. Beginning October 1, 2020, the MI Common Formulary aligned coverage with the MDHHS Fee for Service Single Preferred Drug List. Using one preferred drug list across all managed care plans and Medicaid Fee for Service, helps prescribers and members know what drugs are covered with or without prior approval. 

You can also find information on drug coverage including step therapy, generic substitution process, restrictions of your pharmacy coverage like quantity limits, age limits, and how limits are applied to your coverage on the Michigan Common Formulary linked below. To access the Michigan Common Formulary (which includes the Single Preferred Drug List), please click here. You can also call Member Services at (888) 898-7969, Monday - Friday, 8 a.m. to 5 p.m. EST (TTY: 711) for assistance.

Drugs that are not covered by Molina Healthcare but are covered by Medicaid are subject to Medicaid co-pays.

For a list of pharmacies you can visit for your prescription, please access the link below.

View a list of pharmacies here.

You will need to show your member ID card when filling prescription medications at your pharmacy. For more information on your ID card, please access the Member ID Card page here.

Member Handbook

It tells you what you need to know about your Molina Healthcare of Michigan Medicaid Health Plan. Read here.

How do members get care?

Call Member Services at (888) 898-7969, Monday - Friday, 8 a.m. to 5 p.m. EST (TTY: 711).

• If you are a new Molina Healthcare member and need help with any of your medications.
• You need to ask about a drug.
• You have trouble getting a prescription filled at the pharmacy. (Please do not pay for the prescription.)
  • Prescriptions are covered through Molina Healthcare's contracted pharmacies within Michigan. Prescriptions are covered outside of the state of Michigan (out of area) for emergency or urgent services only.
  • You need an interpreter to communicate with the pharmacy about getting your medication.
  • When you have an emergency and need drugs, Molina Healthcare will provide you with up to a 72-hour supply of the drug.

If you are hearing impaired, please use Michigan Relay at TTY: 711 to speak with a Member Services representative. If you need written materials in a language other than English or require materials in a different format because of special needs, please contact Member Services at (888) 898-7969, Monday - Friday, 8 a.m. to 5 p.m. EST (TTY: 711).

For the full pharmacy provider list, click here.