Prescription Drugs and Medications
What’s covered
Prescriptions: Information about the Molina Healthcare Approved List of Medication and Drugs (The Molina Healthcare Formulary)
Molina Healthcare has a list of pre-approved drugs called a Formulary. The fact that a drug is on the Formulary does not guarantee you will be prescribed that drug. If your prescription is for a drug that is not on the Molina Healthcare Formulary, your PCP or the pharmacy will contact Molina Healthcare and submit a Non Formulary Authorization Request Form. Molina Healthcare will reply to the completed form within 24 hours, Monday through Friday. If you need a prescription filled after business hours, on weekends, or on holidays, your pharmacy will dispense a sufficient supply of Formulary and Non-Formulary medication when medically necessary.
Medications included in Molina Healthcare’s Formulary may have FDA-approved generic equivalents available. Molina Healthcare mandates generic dispensation for all quality generic products. If your PCP indicates that you need a brand name drug, instead of a generic, your provider will need to submit a Non Formulary Authorization Request Form to request Molina Healthcare’s approval of dispensing the brand name drug.
Sometimes the pharmacist must get additional information from your PCP. This may delay the pharmacist from submitting the request to Molina Healthcare. If a delay is expected, Molina Healthcare authorizes enough medication to last you up to 72 hours while any problems are cleared up with your PCP and Molina Healthcare pharmacy. Prior authorization is not required when medications are prescribed in emergent or urgent circumstances.
Molina Healthcare ensures that a sufficient supply (at least 3 days) of medication is dispensed to Molina Healthcare members at a hospital Emergency Department (ED) upon discharge. All hospitals are obligated to provide starter packs as needed to Molina Healthcare members upon discharge from ED or hospital, until the member can reasonably be expected to have a prescription filled at a pharmacy within the Molina Healthcare network.
If you need a refill on your prescription, call your PCP or pharmacy at least three (3) days before you run out of medication. If you are completely out of medically necessary medication, your pharmacist may give you enough medication to last until the refill is authorized or denied.
Paper copies of the Molina Healthcare Formulary may be requested by contacting Member Services at (877) 814-2221.
Evidence of Coverage Handbook
It tells you what you need to know about the Sacramento LIHP Health Plan. Read here.
Find a Pharmacy.
View the Sacramento County LIHP Drug Formulary.