Drug Formulary

2024 Molina Dual Options MI Health Drug Formulary

2024 Prior Authorization Grid

2024 Step Therapy Grid

 2024 Medicare Part D Drug (J-Code) Step Therapy Grid

 Request for Medicare Prescription Drug Coverage Determination

 Request for Redetermination of Medicare Prescription Drug Denial

 Direct Member Reimbursement Form

 

Labeler Reference for NDCs included under the Medicaid Drug Rebate Program

Labeler Reference for NDCs included under the Medicaid Drug Rebate Program

MHP Monthly MDRP Labeler List

 

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