Prescription Drugs
Molina Healthcare Essential Plan Prescription Drug Formulary
Molina uses a Preferred Drug List (Formulary) which is a list of covered prescription and over-the-counter drugs. It is reviewed and approved by doctors and pharmacists. You must get your prescriptions from a pharmacy that is part of the Molina plan. The formulary includes the following options:
- Formulary Preventive Medications
- Formulary Generic Medications
- Formulary Preferred Brand Name Medications
- Formulary Non-Preferred Brand Name Medications
- Formulary Preventive Drugs
Formulary Preventive drugs are drugs listed in the Molina Healthcare Drug Formulary which are considered to be used for preventive purposes, including all methods of birth control approved by the FDA, or if it is being prescribed primarily (1) to prevent the symptomatic onset of a condition in a person who has developed risk factors for a disease that has not yet become clinically apparent or (2) to prevent recurrence of a disease or condition from which the patient has recovered. A drug is not considered preventive if it is being prescribed to treat an existing, symptomatic illness, injury, or condition. Formulary Preventive drugs are offered at No Charge. - Formulary Generic Medications
Formulary Generic drugs are those listed in the Molina Healthcare Drug Formulary that have the same ingredients as brand name drugs. To be FDA (government) approved, the generic drug must have the same active ingredient, strength and dosage (formulation) as the brand name drug. If your doctor orders a brand name drug and there is a Formulary Generic drug available, we will cover the generic medication. Formulary Generic drugs have copayment cost sharing to you. - Formulary Preferred Brand Name Drugs
Formulary Preferred Brand Name drugs are those drugs listed which, due to clinical effectiveness and cost differences, are designated as “Preferred” in the Molina Healthcare Drug Formulary. Formulary Preferred Brand Name drugs are prescription drugs or medicines that have been registered under a brand or trade name by their manufacturer and are advertised and sold under that name, and indicated as a brand in the Medi-Span or similar third party national database used by Molina Healthcare and our pharmacy benefit manager. Formulary Preferred Brand Name drugs have copayment cost sharing to you. - Formulary Non-Preferred Brand Name Drugs
Formulary Non-Preferred Brand Name drugs are those drugs listed in the Molina Healthcare Drug Formulary which are designated as “Non-Preferred” due to lesser clinical effectiveness and cost differences. Formulary Non-Preferred Brand Name drugs are prescription drugs or medicines that have been registered under a brand or trade name by their manufacturer and are advertised and sold under that name, and indicated as a brand in the Medi-Span or similar third party national database used by Molina Healthcare and our pharmacy benefit manager. Formulary Non-Preferred Brand Name drugs have coinsurance cost sharing to you.
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 or complete the form here.
Mail Service Pharmacy
Molina Healthcare wants to offer you a time saving way to get your medicine. You can get a thirty (30) day supply. There are also various maintenance medications for which you can get a 90-day supply. You can also take advantage of your mail service benefit. It is easy.
Subscriber Agreement
It tells you what you need to know about your Molina Healthcare Essential Plan. Read more.
How do Members Get Care?
Your doctor will work with Molina Healthcare to decide which drugs are best for you. Call Member Services to:
- Get a copy of the
2024 Essential Plan Formulary
- Find out if a drug is covered.
- Find out how to appeal a decision.
Molina Healthcare has contracts with certain pharmacies. You must get your drugs at one of these pharmacies. If you need to find a pharmacy that is part of Molina, you may call Member Services. Need to find a pharmacy near you? View the Molina Pharmacy Network.
Call Member Services at (800) 223-7242 (TTY: 711)