Prescription Drugs

presdrugs
Molina Healthcare uses a Preferred Drug List (PDL), which is a list of covered prescription drugs. It is reviewed and approved by doctors and pharmacists. You must get your prescriptions from a pharmacy that is part of the Molina plan.

Generic drugs must be used when the pharmacy has them. There are drugs that may have a limit on how much you can get at one time. They also may have a limit on its strength. Sometimes you have to try other medications first before we approve a drug. This is called Step-Therapy.

Your doctor knows about:

  • The drugs on the Preferred Drug List (PDL).
  • The drugs that need prior approval.
  • How to process special requests.

 

In addition:

  • Your doctor will get prior approval for the drugs that need it.
  • Your doctor may want to give you a drug that is not on the PDL.
  • Your doctor will request an approval through Molina Healthcare’s Pharmacy Department.
  • We will respond to your doctor in (24) hours. If it is the weekend, we will respond the next working day.
  • If the request is approved, we will notify you and your doctor.
  • If a request is denied, a letter will be mailed to you and your doctor.
    • The letter will include the reason for the denial and the appeal rights.
  • If more information is needed from your doctor, your request may be delayed for up to (14) days.

 

You may be taking a drug that is no longer on our PDL. Your doctor can ask us to keep paying for this drug. They can do this by asking for a prior approval. The drug must be safe and FDA approved, for use for a specific and current medical problem.

There are drugs that are not covered. An example would be some drugs for weight loss or cosmetic purposes.

Mail Service Pharmacy
Molina Healthcare wants to offer you a time saving way to get your medicine. You can get a thirty (30) day supply. Take advantage of your mail service benefit. It is easy.

icon PDF Mail Order documents

Member Handbook
It tells you what you need to know about your Molina Healthcare of New York Medicaid Managed Care (MMC) Health Plan. Read more.

How do members get care?
Your doctor will work with Molina Healthcare to decide which drugs are best for you. Call Member Services to:

Get a copy of the icon PDF 2021 Preferred Medicaid Drug List

Get a copy of the icon PDF Behavioral Health Formulary Updates

Get information about prescription drugs.

Find out if a drug is covered.

Find out how to appeal a decision.

Molina Healthcare has contracts with certain pharmacies. You must get your drugs at one of these pharmacies. If you need to find a pharmacy that is part of Molina, you may call Member Services or Find a Pharmacy near you today.

Important Links

icon PDF 2021 Preferred Medicaid Drug List
icon PDF Behavioral Health Formulary Updates
Find a Pharmacy

Single Statewide Medication Assisted Treatment (MAT) Formulary

STARTING OCTOBER 1, 2021.The New York State Executive Budget for State Fiscal Year 2020-2021, in accordance to § 367-a (7) (e) of Social Services Law, enacts a statewide formulary for Opioid Antagonists and Opioid Dependence Agents for Medicaid Managed Care (MC) Plans and Medicaid Fee for Service (FFS) Program,  Under this statewide formulary (link provided below), Medicaid MC and FFS members will follow a single formulary, where preferred products and coverage parameters are consistent across the Medicaid Program.

For more information, please visit https://newyork.fhsc.com/providers/mat.asp.

 

icon PDF Adobe Acrobat Reader is required to view the file(s) above. Download a free version