Prescription medications are covered when:
- They are ordered by your provider or another doctor treating you or your child and the drug is listed on the Molina Healthcare Drug List (Formulary).
- The Drug Formulary is Molina Healthcare’s list of approved drugs that doctors can order for you.
- They are ordered or given while you are in an emergency room or hospital.
- They are given while you are in a rest home, nursing home or convalescent hospital and they are ordered by a plan doctor for a covered service. You will get them through a pharmacy that is in the Molina Healthcare Pharmacy Network.
- They are prescribed by a family planning doctor or other provider whose services do not require an approval.
Generic drugs 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 generic available, Molina Healthcare will cover the generic medication. If your doctor says that you must have the brand name drug instead of the generic, he/she must submit a prior authorization request to Molina Healthcare’s Pharmacy Department.
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
- 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
Member Exception Form
Member Services Guide
It tells you what you need to know about your Molina Healthcare Medi-Cal Health Plan.
For the Member Service Guide, click here.
Medi-Cal Member Services Guide - Notice of Nondiscrimination and Language Assistance Addendum, click here.
How do members get care?
Call Member Services at (888) 665-4621, Monday to Friday, 7 a.m. - 7 p.m. if:
- 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 California. Prescriptions are covered outside of the state of California (out of area) for emergency or urgent services only.
- You need an interpreter to communicate with the pharmacy about getting your medication.
- 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 deaf or hard of hearing, call our TTY line at (800) 479-3310 or contact us with the California Relay Service by dialing 7-1-1.
Find a Pharmacy.
View the Molina Healthcare Medi-Cal Drug Formulary Update - April 2015
Synagis Authorization Form
Member Exception Form