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. 
 
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) 560-5716, Monday to Friday, 8:00 a.m. - 6:00 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 Florida
    • Prescriptions are covered outside of the state of Florida (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 our TTY line at (800) 346-4128 or contact us through the National Relay Service by dialing 711.

     

Find a Pharmacy.