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Members

Prescription Drugs

Hand holding prescription drug pill bottle

Prescription medications are covered when:

Prescription Reimbursement Form  

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 below.

Member Exception Form

Specialty Oral and Injectable Drugs

Specialty drugs are prescription legend drugs within the Molina Healthcare Drug Formulary which:

  • Are only approved to treat limited patient populations, indications or conditions; or
  • Are normally injected, infused or require close monitoring by a physician or clinically trained individual; or
  • Have limited availability, special dispensing, handling and delivery requirements, and/or require additional patient support, any or all of which make the drug difficult to obtain through traditional pharmacies.

 

Molina Healthcare may require that Specialty drugs be obtained from a participating specialty pharmacy or facility for coverage. Molina Healthcare’s specialty pharmacy will coordinate with You or Your physician to provide delivery to either Your home or Your provider’s office. Specialty Oral and Injectable drugs have Coinsurance Cost Sharing to You.


 

Mail order availability of Formulary Prescription Drugs
Molina offers You a mail order drug benefit on most of our formulary long term use drugs. Formulary Prescriptions drugs can be mailed to You within 10 days from order request and approval. Cost Sharing is a 90- day supply applied at two times Your appropriate Copayment or Percentage Cost Sharing based on Your drug tier for one month.

You may request mail order service in the following ways:

  • You can also complete a Mail Service Order Form
  • You can call the FastStart® toll-free number at 1 (800) 875-0867. Provide Your Molina Marketplace Member number (found on Your ID card), Your prescription name(s), Your doctor’s name and phone number, and Your mailing address.
  • You can give Your doctor’s office the toll-free FastStart® physician number 1 (800) 378-5697, and ask Your doctor to call, fax, or electronically prescribe Your prescription. To speed up the process, Your doctor will need Your Molina Marketplace Member number (found on Your ID card), Your date of birth, and Your mailing address.

How do members get care?
Call Member Services​ 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 your service area. Prescriptions are covered outside of service area for emergency or urgent services only.
    • You need an interpreter to communicate with the pharmacy about getting your medication.
  • If you are deaf or hard of hearing, contact us through the National Relay Service by dialing 711.


Find a Pharmacy.

​​​​​​​​

Prescription medications are covered when:

Prescription Reimbursement Form  

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 below.

Member Exception Form

Specialty Oral and Injectable Drugs

Specialty drugs are prescription legend drugs within the Molina Healthcare Drug Formulary which:

  • Are only approved to treat limited patient populations, indications or conditions; or
  • Are normally injected, infused or require close monitoring by a physician or clinically trained individual; or
  • Have limited availability, special dispensing, handling and delivery requirements, and/or require additional patient support, any or all of which make the drug difficult to obtain through traditional pharmacies.

 

Molina Healthcare may require that Specialty drugs be obtained from a participating specialty pharmacy or facility for coverage. Molina Healthcare’s specialty pharmacy will coordinate with You or Your physician to provide delivery to either Your home or Your provider’s office. Specialty Oral and Injectable drugs have Coinsurance Cost Sharing to You.


 

Mail order availability of Formulary Prescription Drugs
Molina offers You a mail order drug benefit on most of our formulary long term use drugs. Formulary Prescriptions drugs can be mailed to You within 10 days from order request and approval. Cost Sharing is a 90- day supply applied at two times Your appropriate Copayment or Percentage Cost Sharing based on Your drug tier for one month.

You may request mail order service in the following ways:

  • You can also complete a Mail Service Order Form
  • You can call the FastStart® toll-free number at 1 (800) 875-0867. Provide Your Molina Marketplace Member number (found on Your ID card), Your prescription name(s), Your doctor’s name and phone number, and Your mailing address.
  • You can give Your doctor’s office the toll-free FastStart® physician number 1 (800) 378-5697, and ask Your doctor to call, fax, or electronically prescribe Your prescription. To speed up the process, Your doctor will need Your Molina Marketplace Member number (found on Your ID card), Your date of birth, and Your mailing address.

How do members get care?
Call Member Services​ 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 your service area. Prescriptions are covered outside of service area for emergency or urgent services only.
    • You need an interpreter to communicate with the pharmacy about getting your medication.
  • If you are deaf or hard of hearing, contact us through the National Relay Service by dialing 711.


Find a Pharmacy.

​​​​​​​​
 

​Language Information

If you, or someone you’re helping, has questions about Molina Marketplace, you have the right to get help and information in your language at no cost. To talk to an interpreter, call 1 (888) 560-2043.

Información de idioma

Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Molina Healthcare tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al 1-888-560-4087.

معلومات اللغة

إن كان لديك أو لدى شخص تساعده أسئلة بخصوص Molina Marketplace ، فلديك الحق في الحصول على المساعدة والمعلومات الضرورية بلغتك من دون اية تكلفة. للتحدث مع مترجم اتصل بـ 4087-560-888-1.

语言信息

如果您,或是您正在協助的對象,有關於[插入SBM項目的名稱 Molina Marketplace 方面的問 題,您有權利免費以您的母語得到幫助和訊息。洽詢一位翻譯員,請撥電話 [在此插入數字 1-888-560-4087。

ܛܸܒܸܐ ܕ ܠܸܫܵܢܵܐ

.1-888-560-4087 ܐܢܝܢܡ ܢܘܦܝܠܬܢܘܬܚܐ ،Molina Marketplace ܬܘܒ ܐܪܩܘܒ ܢܘܟܘܠܬܝܐ ،ܢܘܬܝ ܝܗܘܪܘܝܗܕ ܐܦܘܨܪܦ ܕܚ ܘܐ ،ܢܘܬܚܐ ܢܐ ܠܥ ܢܘܪܩ ،ܐܢܡܓܪܬܡ ܕܚ ܡܥ ܐܡܘܙܡܗܠ .ܬܝܐܢܓܡ ܢܘܟܘܢܫܠܒ ܐܬܘܢܥܕܘܡܘ ܐܬܪܝܗ ܢܘܬܝܠܒܩܕ ܐܬܘܩܗ ܢܘܟܘܠܬܝܐ

​Thông Tin Ngôn Ngữ

Nếu quý vị, hay người mà quý vị đang giúp đỡ, có câu hỏi về Molina Marketplace, quý vị sẽ có quyền được giúp và có thêm thông tin bằng ngôn ngữ của mình miễn phí. Để nói chuyện với một

Informacioni i gjuhës

Nëse ju, ose dikush që po ndihmoni, ka pyetje për Molina Marketplace, keni të drejtë të merrni ndihmë dhe informacion falas në gjuhën tuaj. Për të folur me një përkthyes, telefononi numrin 1-888-560-4087.

언어 정보

만약 귀하 또는 귀하가 돕고 있는 어떤 사람이Molina Marketplace 에 관해서 질문이 있다면 귀하는 그러한 도움과 정보를 귀하의 언어로 비용 부담없이 얻을 수 있는 권리가 있습니다. 그렇게 통역사와 얘기하기 위해서는1-888-560-4087 로 전화하십시오.

ভাষা বিষয়ক তথ্য

যদি আপদি, অথবা আপদি অিয কাউকক সহায়তা করকেি, সম্পকক প্রশ্ন আকে Molina Marketplace,আপিার অদিকার আকে দবিা খরকে আপিার দিজস্ব ভাষাকত সাহাযয পাবার এবং তথয জািবার। অিুবািককর সাকথ কথা বলার জিয, কল করুি 1-888-560-4087.

Informacja językowa

Jeśli Ty lub osoba, której pomagasz ,macie pytania odnośnie Molina Marketplace, masz prawo do uzyskania bezpłatnej informacji i pomocy we własnym języku .Aby porozmawiać z tłumaczem, zadzwoń pod numer 1-888-560-4087.

Sprachinformation

Falls Sie oder jemand, dem Sie helfen, Fragen zum Molina Marketplace haben, haben Sie das Recht,kostenlose Hilfe und Informationen in Ihrer Sprache zu erhalten. Um mit einem Dolmetscher zu sprechen, rufen Sie bitte die Nummer 1-888-560-4087 an.

Informazioni sui servizi linguistici

Se tu o qualcuno che stai aiutando avete domande su Molina Marketplace, hai il diritto di ottenere aiuto e informazioni nella tua lingua gratuitamente. Per parlare con un interprete, puoi chiamare 1-888-560-4087.

言語情報

ご本人様、またはお客様の身の回りの方でも、Molina Marketplace についてご質問がございま したら、ご希望の言語でサポートを受けたり、情報を入手したりすることができます。料金 はかかりません。通訳とお話される場合、1-888-560-4087までお電話ください。

Информация о языках

Если у вас или лица, которому вы помогаете, имеются вопросы по поводу Molina Marketplace,то вы имеете право на бесплатное получение помощи и информации на вашем языке. Для разговора с переводчиком позвоните по телефону 1-888-560-4087.

Jezik informacije

Ukoliko Vi ili neko kome Vi pomažete ima pitanje o Molina Marketplace, imate pravo da besplatno dobijete pomoć i informacije na Vašem jeziku. Da biste razgovarali sa prevodiocem, nazovite 1-888-560-4087.

Impormasyon sa Wika

Kung ikaw, o ang iyong tinutulangan, ay may mga katanungan tungkol sa Molina Marketplace, may karapatan ka na makakuha ng tulong at impormasyon sa iyong wika ng walang gastos. Upang makausap ang isang tagasalin, tumawag sa 1-888-560-4087.

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