Members

Prescription Drugs

presdrugs
The Molina Pharmacy Benefit moved to Medi-Cal Rx on 01/01/2022 for more information click here. 


What’s covered

As of January 1, 2022, Outpatient Prescription medications are administered by Medi-Cal Rx and are covered when:

  • They are ordered by your provider or another doctor treating you or your child and the drug is listed on the Medi-Cal Rx Contract Drug List
    • The Contract Drug List (CDL) is Medi-Cal Rx’s list of approved drugs that doctors can order for you. The CDL is available on the Medi-Cal Rx website: medi-calrx.dhcs.ca.gov/home/cdl

    • On the Contract Drug List (CDL) you can find information related to quantity limits, age limits, how limits are applied to your coverage, and drugs that require prior authorization (PA). For any additional information on drug coverage including step therapy and generic substitution, please contact Medi-Cal RX.

  • 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 Medi-Cal Rx Network.

  • For additional information on your pharmacy benefit thru Medi-Cal RX, please refer to the Medi-Cal RX Members’ Frequently Asked Questions (FAQs). Here you can find an overview of Medi-Cal RX including information on using your ID card at your pharmacy, how to find a pharmacy using the tool linked above, an explanation of the prior authorization process, and how to use the Medi-Cal RX member portal. The FAQ document can be found by accessing the following link medi-calrx.dhcs.ca.gov/member/.

  • They are prescribed by a family planning doctor or other provider whose services do not require approval.

  • Your doctor can submit a Prior Authorization to Medi-Cal Rx for medications not listed on the Medi-Cal Rx Contracted Drug List. Your Doctor can find more information on how to submit your Prior Authorization to Medi-Cal RX by using the provider portal.
      

For more information, see medi-calrx.dhcs.ca.gov or call 1-800-977-2273, or for TTY call 711, 24 hours a day.

Molina Healthcare will cover your Inpatient medications when they are ordered and given while you are in an emergency room or hospital.

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.