|Does Molina Healthcare cover prescription drugs?
Yes. As a member of Molina Healthcare, your child has no co-pays or out-of-pocket costs for prescription medications. You should never pay for your child’s prescriptions. Go to the Prescription Drugs page to learn more. Our Pharmacy Department can help you get the prescription medications your child needs. For some medications, you will need to get prior authorization. Learn more.
To find out what drugs are covered under your plan, view the Molina Healthcare Preferred Drug List (Formulary) for your plan in “What’s Covered”.
|What is the Preferred Drug List?
||Molina Healthcare’s preferred drug list is a specific list of drugs Molina Healthcare has approved. Providers use it when prescribing a drug. If your child uses a drug on the list, Molina Healthcare will pay for it. This means your child can get his or her medicine at no cost to you.|
|What drugs are on the Preferred Drug List?
||There are many drugs on the Preferred Drug List. The list includes both brand-name and generic drugs. Click here to view the Preferred Drug List. To get a printed copy, call Member Services.|
|What if my child’s drug is not on the Preferred Drug List?
||If you find out that your child’s drug is not on the list, call Member Services. Ask them to make sure that your child’s drug is not on the Preferred Drug List. If they say it is not on the list ask your doctor if you can switch to another drug that we do cover. Give your doctor a list of the drugs we pay for. He or she may find another drug on the list that treats your child’s medical condition the same way. To get a copy of the list, contact Member Services review the Preferred Drug List here. We will work with you to find a drug that meets your child’s needs. If a drug is not on our list, your doctor must send us a prior authorization request. We will review your doctor’s reason for the drug that is not on our list. If we approve it, we will pay for your child’s drug. |
|What is Molina Healthcare’s policy on brand name drugs?
||Generic drugs have the same ingredients as brand name drugs. At Molina Healthcare, we call generic drugs our preferred drugs. We require the use of a preferred drug from our preferred drug list (PDL) if one is available. Our Pharmacy Department will work with your provider if he or she says your child needs the brand name instead of the preferred drug. Your provider will submit a prior authorization request to our Pharmacy Department explaining why the preferred medicine will not work for your child. We review each prior authorization request carefully, considering the needs of your child first, and let you and your provider know of our decision. Learn more.|
|Is my child’s durable medical equipment (DME) covered?
||Molina Healthcare works with DME companies. These companies provide all the equipment and supplies for your child’s medical needs. View our Provider Directory to see the DME suppliers in our provider network. |
|How does Molina Healthcare decide which drugs to put on the Preferred Drug List?
The drugs on this list are chosen by a committee made up of doctors and pharmacists. They are from Molina Healthcare and from the medical community. The committee reviews the list every three months and decides which drugs should be on the list. The drugs chosen are the ones that will serve you best.
The committee also reviews FDA (Food and Drug Administration) reports. These reports talk about new drugs the FDA says are okay for use. They also talk about how well current drugs work. The reports help them know if they should add drugs to the list or take some off.
|What type of service should you expect from a network pharmacy?
There are certain services you should get from our network pharmacies. They help you know how your child can take his or her medicine the safe and healthy way.
When you go to a network pharmacy:
- You should expect to be asked if you want to speak with a pharmacist. This is called a patient consult.
- During a consult you can ask the pharmacist:
- How your child can take their medicine.
- When your child should take it. For example, you might need to take it with or without food.
- How your child can take his or her drug the safe way.
- During the consult, the pharmacist may tell you:
- What the drug is for and how it works.
- Side effects the drug may cause.
- How to store the drug. Some drugs must be kept at a certain temperature or in a certain light so they won’t be ruined.
- About any other drugs your child should not take. Sometimes when two drugs are taken together, it can be dangerous for your child or can stop his or her medicine from working. Ask your pharmacist about any drug interactions.
- You can also ask for a medication profile review. This is when a pharmacist checks the computer for all of the drugs your child is taking. You will be told the best way to take each one throughout the day. The pharmacist will also make sure it is safe for your child to take the drugs together during the day. If your child takes any vitamins or herbal remedies, now is the time to tell your pharmacist. He or she will let you know if it is okay to take them with your child’s other drugs.
- Ask if your language (of choice) can be put on the Rx bottle. Also ask if the directions for how to take the drug can be written in your language.
- During flu season, some of the network pharmacies may offer flu shots for your child as a Molina Healthcare member free of charge. Ask if your pharmacy offers flu shots for Molina Healthcare members.
You should expect these services from your pharmacy. Be sure to use the benefits your pharmacy offers. We only choose network pharmacies that serve your child best. We work with our network pharmacies to keep your child safe and healthy.