Your plan covers a range of birth control services and prescription and over-the-counter (OTC) products with $0 member cost-sharing. Plan network rules apply.
Pharmacy benefit coverage
See your plan’s Forms & Documents for which birth controls are covered with a doctor’s prescription or over-the-counter at a pharmacy. We will cover up to a 6 month’s supply of prescription birth control at one time, but not OTC products.
- Birth control pills
- Contraceptive patches
- Contraceptive rings
- Barrier products (OTC condoms, caps, and diaphragms)
- Spermicides (OTC)
- Emergency birth control or “morning after” pills (prescription and OTC)
There are no requirements to try other drugs first or to get approval from Molina for birth control products that are on the formulary. If you have a medical reason for why you must use a non-formulary product, your doctor can send us a formulary exception request using our standard prior authorization process.
Under state rules, qualified pharmacists may be able to dispense certain prescription or over-the-counter birth control products to you using your pharmacy benefit without a doctor’s prescription.
You can also buy over-the-counter emergency birth control pills listed on the formulary and mail a refund request with your receipt using a claim form.
Medical benefit coverage
Your plan follows national rules for services and patient education relating to birth control and family planning.
- Sterilization surgery (tubal ligation or vasectomy)
- Birth control shots
- Intrauterine devices (IUDs)
- Contraceptive implants
- Contraceptives given after child delivery, before hospital discharge
If you have questions about birth control coverage under your plan, you can call Molina at 1 (888) 295-7651 Monday through Friday, 8am - 6pm local time.
If your provider sent a formulary exception request and it was not approved, you have the option to send an appeal or grievance.
You may file your grievance via phone, mail, electronic mail (e-mail), fax, or on the Molina Healthcare website below. Please submit your written grievance to:
Molina Healthcare of New Mexico Grievance and Appeals Unit
400 Tijeras Ave. NW, Suite 200
Albuquerque, NM 87102
Fax #: (505) 342-0583
E-Mail: Marketplace.Grievances@MolinaHealthCare.Com
Website: https://www.molinamarketplace.com/marketplace/nm/en-us/Members/Members-Resources/gna
Phone: 1 (888) 295-7651. Hearing Impaired: TTY line toll free at 1 (800) 659-8331
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