Prescription medications are covered when:
- Medically necessary.
- Ordered by your provider who has a contract with Molina Healthcare. Check Find a Provider to see if your provider is contracted with Molina Healthcare.
- The drug is listed on the Molina Healthcare Preferred Drug List (PDL).
- The PDL is Molina Healthcare’s list of approved drugs that providers can order for you.
- Received through a pharmacy that is in the Molina Healthcare Pharmacy Network.
- Given while you are in a rest home, nursing home or convalescent hospital.
As an additional benefit, Molina Healthcare covers a 30-day supply of prescription drugs mailed to your home. Molina Healthcare also covers the over-the-counter drugs on our PDL at no cost to you. You will need a prescription from your provider for the over-the-counter drug to be covered by Molina Healthcare.
Note: Certain medications need prior approval by Molina Healthcare. Your provider needs to send Molina Healthcare a request and get prior authorization before these drugs will be covered.
Some prescriptions that are not on the PDL require prior approval. Medications that are approved outside of the PDL need to be medically necessary. Sometimes this is done when PDL options have not worked or can’t be taken according to your doctor. When this happens your doctor may fax a completed drug prior authorization form to Molina at (855) 365-8112.
Your and your doctor can find the prior authorization criteria Molina at Molina Medical Coverage Guidelines. Please ask your healthcare provider if you have any questions. Trials of pharmaceutical samples will not be considered for approving a prior authorization request. Generic medications. Generic drugs 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 as the brand name drug.
- If your provider orders a brand name drug and there is a generic available, Molina Healthcare will cover the generic medication. If your provider says you must have the brand name drug instead of the generic, he/she must submit a prior authorization request to Molina Healthcare’s Pharmacy Department.
It tells you what you need to know about your Molina Healthcare HealthChoice Illinois plan Member Handbook.
How do Members get care?
Call Member Services at (855) 687-7861, Monday to Friday, 8 a.m.- 5 p.m. if:
- You have questions about if a drug is covered.
- You have trouble getting a prescription filled at the pharmacy. (Please do not pay for the prescription.)
- You need an interpreter to communicate with the pharmacy about getting your medication.
Prescriptions are covered through Molina Healthcare’s contracted pharmacies in Illinois. Prescriptions are covered outside of Illinois for emergency or urgent needs only. When you have an emergency and need a prescription filled, your pharmacy can provide you with up to a 72-hour supply.