Prescription Drugs
Comprehensive Drug List (CDL):
What's covered?
There may be times when your practitioner/provider prescribes a medication for you. The prescriptions for your medications can be filled at most retail pharmacies.
Molina Healthcare uses a special list of drugs. It is called a Comprehensive Drug List. Molina Healthcare's list of drugs can be prescribed for you by your practitioner/provider.
- This list is given to Primary Care Providers (PCPs) and specialists. Your PCP can tell you if the drug you need is on the list. If the drug is not on the Comprehensive Drug List, your PCP has to get approval.
- Your PCP must submit a prior authorization form to Molina Healthcare. The prior authorization form should explain why you need a drug not on the list.
Exceptions to Rejected Medications
- Your doctor can ask Molina Healthcare to cover a drug not on this list. This is called an “exception”. Your doctor can ask for a prior authorization. They ask Molina Healthcare for the prior authorization.
- If your doctor’s prior authorization request for an exception is not approved, you have a right to appeal that decision. You have a right to get another review. You will get a denial letter from Molina Healthcare. Your doctor will get a denial letter from Molina Healthcare. The letter will tell you how to ask for an appeal.
Members Getting an Exception to the Comprehensive Drug List (CDL)
Drugs not listed on the Comprehensive Drug List require an exception request called a prior authorization. For drugs not listed on the Comprehensive Drug List, you have the following options:
- You can ask your doctor to order a similar drug listed on the CDL.
- You can ask your doctor to submit a prior authorization request so your non-listed drug may be reviewed for coverage by your benefit.
- You can start the request for an exception for a non-listed drug.
- If you want to start the exception process, you can call Member Services at (855) 882-3901 or complete the Non-Listed Medication Exception Member Inquiry Form and send it to us.
How do Members Get Care?
If you have questions about the Comprehensive Drug List or prior authorizations, call Molina Healthcare at (855) 882-3901.
Medication Refills
The pharmacy can give you a refill on your medication. You can get a refill if your doctor has ordered one. The pharmacy cannot refill your medication more than five (5) days before the refill date. They cannot refill it before three fourths (3/4) of your medication has been used.
Prescription Mail Service Order Form
View the Mail Service Order Form to receive certain medications by mail.
What is a prior authorization request?
A prior authorization request is how your doctor may ask for a particular medication to be covered. If the request is approved, your prescription cost will be paid by Molina Healthcare. If the request is not approved, your doctor may choose a different medication, or you can appeal the decision.
A prior authorization request is how your doctor may ask for a particular medication to be covered. If the request is approved, your prescription cost will be paid by Molina Healthcare. If the request is not approved, your doctor may choose a different medication, or you can appeal the decision.
What is a Comprehensive Drug List?
Molina Healthcare of South Carolina uses a Comprehensive Drug List, which lists the drugs covered by the health plan. This list was carefully created by a group of pharmacists and physicians. Molina Healthcare of South Carolina uses a Comprehensive Drug List, which lists the drugs covered by the health plan. The list was carefully created by a group of pharmacists and physicians. Molina’s Comprehensive Drug List combines drugs on the SPDL with additional drugs/services that we approve in addition to those listed on the SPDL.
Molina Healthcare of South Carolina uses a Comprehensive Drug List, which lists the drugs covered by the health plan. This list was carefully created by a group of pharmacists and physicians. Molina Healthcare of South Carolina uses a Comprehensive Drug List, which lists the drugs covered by the health plan. The list was carefully created by a group of pharmacists and physicians. Molina’s Comprehensive Drug List combines drugs on the SPDL with additional drugs/services that we approve in addition to those listed on the SPDL.
Why must I use Comprehensive Drug List drugs?
Comprehensive Drug List drugs were selected because they are quality medications of good value. They are often the best choices to treat medical and behavioral conditions.
Comprehensive Drug List drugs were selected because they are quality medications of good value. They are often the best choices to treat medical and behavioral conditions.
What if I have a prescription for a drug not listed on the Comprehensive Drug List?
You may ask your doctor to switch to another medication on the Comprehensive Drug List and covered by your health plan, or your doctor can submit a prior authorization request to Molina Healthcare.