Formulary (List of Covered Drugs)
Search the 2020 Formulary for the Prescription Drugs you may need.
Search the 2021 Formulary for the Prescription Drugs you may need.Please note: Members can contact the plan for a printed copy of the most recent list of drugs or view the link below. You can contact our Pharmacy team at (888) 665-1328, TTY 711, 7 days a week, 8:00 am to 8:00 pm local time, for additional information or visit www.MolinaHealthcare.com/Medicare.
The formulary is a list of covered drugs. Molina Medicare will generally cover any prescription drug listed in our formulary as long as:
- the drug is medically necessary,
- the prescription is filled at a Molina Medicare network pharmacy,
- and other plan rules are followed.
Can the Formulary Change?
We may add or remove drugs from the formulary during the year. Changes in the formulary may affect which drugs are covered and how much you will pay when filling your prescription. If we remove drugs from the formulary, or add prior authorizations, quantity limits and/or step therapy restrictions on a drug, and you are taking the drug affected by the change, we will notify you of the change at least 60 days before the date that the change becomes effective. However, if a drug is removed from our formulary because the drug has been recalled from the market, we will not give 60 days notice before removing the drug from the formulary. Instead, we will remove the drug from our formulary immediately and notify members about the change as soon as possible.
For more information on covered drugs and how to fill your prescriptions, including obtaining prescriptions at Out-of-Network Pharmacies Molina Medicare Complete Care (PDF) and how to get a temporary supply of drugs as a new member see Transition Policy (PDF below). You can ask Molina Medicare to make an exception to our coverage rules by completing the Coverage Determination Request form or the Drug Determination Request Form (See Forms Page).
The files below are in PDF format. ()
- Medication Safety - Molina Medicare Complete Care (HMO SNP)
- Transition Policy - Molina Medicare Complete Care (HMO SNP)
- Rx Mail Order Form - Molina Medicare Complete Care (HMO SNP)
- 2020 Prior Authorization Grid - Molina Medicare Complete Care (HMO SNP)
- 2020 Step Therapy Grid - Molina Medicare Complete Care (HMO SNP)
- 2020 Comprehensive Formulary
- 2021 Prior Authorization Grid - Molina Medicare Complete Care (HMO SNP)
- 2021 Step Therapy Grid - Molina Medicare Complete Care (HMO SNP)
- 2021 Comprehensive Formulary
Adobe Acrobat Reader is required to view the file(s) above. Download a free version.