Pharmacy

For Pharmacy forms, please go to our Forms page.

  • Preferred Drug List

    Molina Healthcare has a list of covered drugs that are selected by us with the help of a team of doctors and pharmacists.

    This list of covered drugs also includes all the drugs on the DMAS Preferred Drug List (PDL). The list includes drugs covered by us and tells you if there are any rules or restrictions on them, such as a limit on the amount a member can get.

    Molina will pay up to $50 per quarter for select over-the-counter (OTC) products for members with an active prescription from a participating provider. These products can include:

    • Vitamins
    • Cough and cold medicines
    • Antihistamines
    • Antacids
    • Artificial tears
    • Topical antibiotics
    • Antifungals
    • Gastrointestinal medicines

    Searchable Formulary 

    Formulary search tool

    Please review this list to find out what drugs are covered by Molina. If you would like a paper copy of the list of covered drugs, please call us and we will mail a copy to you. Please be aware that this list may change throughout the year.




    Preferred insulin pens/needles, Self-Blood Glucose Monitoring (SBGM) and supplies

    Molina Healthcare is an existing plan sponsor with CVS Caremark®. Here is a list of preferred diabetic supplies:  

    Meters

    Trividia Health Billing Information

    BIN: 018844

    PCN: 3F

    ID: TRPT5023493

    SUBGROUP: FVTRUEPORT50

    These meters are preferred but are only covered through a free manufacturer program with the following point-of-sale processing information:
    • True Metrix Blood Glucose Test Strip
    • True Metrix Meter Kit w/Device
    • True Metrix Meter Kit w/Device
    • True Metrix Air Glucose Meter Kit w/Device
    • ReliOn True Met Air Glucose Meter Kit w/Device
    • True Metrix Air Glucose Meter Device
    • True Metrix Air Glucose Meter Kit w/Device

     

    Test strips
    • ReliOn True Metrix Test Strips
    • True Metrix Blood Glucose Test

    Pens/needles
    • TechLITE Insulin Syringe
    • TechLite Pen Needles
    • TRUEplus 5-Bevel Pen Needles
    • TRUEplus Insulin Syringe
    • TRUEplus Pen Needle

    If you prescribe a drug that is impacted by a change to the list of covered drugs, you will be notified in writing 30 days prior to the change taking effect.

    List of covered drugs -- Effective July 2023

    List of covered drugs -- Effective October 2023

    List of covered drugs     -- Effective January 2024

    icon Physician Administered Preferred Drug List -- Updated February 2024

     

 

 

 

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