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Members

Prescription Drugs

Prescription Drugs

Prescription medications are covered when:

 
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.
 
How do members get care?
Call Member Services at (888) 858-3492, Monday to Friday, 8:00 a.m. - 5:00 p.m. local time 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 Washington
    • Prescriptions are covered outside of the state of Washington (out of 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, call the National Relay Service by dialing 711.
  • You can also complete a Mail Service Order Form

Find a Pharmacy.

Prescription medications are covered when:

 
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.
 
How do members get care?
Call Member Services at (888) 858-3492, Monday to Friday, 8:00 a.m. - 5:00 p.m. local time 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 Washington
    • Prescriptions are covered outside of the state of Washington (out of 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, call the National Relay Service by dialing 711.
  • You can also complete a Mail Service Order Form

Find a Pharmacy.

 

​Language Information

If you, or someone you’re helping, have 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 1-888-858-3492.

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 1-888-858-3492.

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 1-888-858-3492。

Thông Tin Ngôn Ngữ

Nếu quý vị, hay người mà quý vị đang giúp đỡ, có câu hỏi về Molina Marketplace, quý vị sẽ cóquyền được giúp và có thêm thông tin bằng ngôn ngữ của mình miễn phí. Để nói chuyện với một thông dịch viên, xin gọi 1-888-858-3492.

​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 위해서는1-888-858-3492 로 전화하십시오.

​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 1-888-858-3492.

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 1-888-858-3492.

Выберите язык

Якщо у Вас чи у когось, хто отримує Вашу допомогу, виникають питання Molina Marketplace, у Вас є право отримати безкоштовну допомогу та інформацію на Вашій рідній мові. Щоб зв’язатись з перекладачем, задзвоніть на 1-888-858-3492.

​សេវាកម្មភាសា

ប្រសិនបើអ្នក ឬនរណាម្នាក់ដែលអ្នកកំពុងតែជួយ មានសំណួរអំពី Molina Marketplace ទេ, អ្នកមានសិទ្ធិទទួលជំនួយនិងព័ត៌មាន នៅក្នុងភាសា របស់អ្នក ដោយមិនអស់ប្រាក់ ។ ដើម្បីនិយាយជាមួយអ្នកបកប្រែ សូម 1-888-858-3492 ។

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、1-888-858-3492 までお電話ください。

የቋንቋ መረጃ

እርስዎ፣ ወይም እርስዎ የሚያግዙት ግለሰብ፣ ስለ Molina Marketplace ጥያቄ ካላችሁ፣ ያለ ምንም ክፍያ በቋንቋዎ እርዳታና መረጃ የማግኘት መብት አላችሁ። ከአስተርጓሚ ጋር ለመነጋገር፣ 1- 888-858-3492 ይደውሉ።

​Afaan odeeffannoo

Isin yookan namni biraa isin deeggartan Molina Marketplace irratti gaaffii yo qabaattan, kaffaltii irraa bilisa haala ta’een afaan keessaniin odeeffannoo argachuu fi deeggarsa argachuuf mirga ni qabdu. Nama isiniif ibsu argachuuf, lakkoofsa bilbilaa 1-888-858-3492 tiin bilbilaa.

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 3492-858-888-1 .

ਭਾਸ਼ਾ ਦੀ ਜਾਣਕਾਰੀ

ਜੇ ਤੁਹਾਨੰ ੂ , ਜ􀁿 ਤੁਸੀ ਿਜਸ ਦੀ ਮਦਦ ਕਰ ਰਹੇ ਹੋ , Molina Marketplace ਕੋਈ ਸਵਾਲ ਹੈ ਤ􀁿, ਤੁਹਾਨੰ ੂ ਿਬਨਾ ਿਕਸ ੇ ਕੀਮਤ 'ਤੇ ਆਪਣੀ ਭਾਸ਼ ਿਵੱਚ ਮਦਦ ਅਤੇ ਜਾਣਕਾਰੀ ਪ􀂇ਾਪਤ ਕਰਨ ਦਾ ਅਿਧਕਾਰ ਹੈ . ਦੁਭਾਸ਼ੀ ਨਾਲ ਗੱਲ ਕਰਨ ਲਈ, 1-888-858-3492 ਤੇ ਕਾਲ ਕਰੋ .

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 1-888-858-3492 an.

ຂໍ້ມູນພາສາ

ຖ້າທ່ານ, ຫຼືຄົນທີ່ທ່ານກໍາລັງຊ່ວຍເຫຼືອ, ມີຄໍາຖາມກ່ຽວກັບ Molina Marketplace, ທ່ານມີສິດທີ່ຈະໄດ້ຮັບການຊ່ວຍເຫຼືອແລະຂໍ້ມູນຂ່າວສານທີ່ເປັນພາສາຂອງທ່ານບໍ່ມີຄ່າໃຊ້ຈ່າຍ. ການໂອ້ລົມກັບນາຍພາສາ, ໃຫ້ໂທຫາ 1-888-858-3492.

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