Members of Molina Healthcare have no co-pays or out-of-pocket costs for covered prescription medications.
Molina Healthcare also uses an Over-The-Counter (OTC) and Durable Medical Equipment (DME) Products List. These products are available at no cost through the Molina Healthcare Medicaid pharmacy benefit. A prescription is required for these products.
Prescription medications are covered when:
- They are ordered by your provider or another provider treating your child and 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.
- They are ordered or given while your child is in an emergency room or hospital.
- They are prescribed by a provider care provider (PCP)or other provider whose services do not require an approval.
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(formulation) 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 that you must have the brand name drug instead of the generic, he/she must submit a prior authorization request form to Molina Healthcare’s Pharmacy Department explaining why the preferred medicine will not work for you. We review prior authorizations on an individual basis and consider your needs.
- Medications that require prior authorization can be found on the Molina Healthcare Prior Authorization (PA) List.
It tells you what you need to know about your child’s Molina Healthcare of Ohio Medicaid Health Plan. Read more.
How do members get care?
Call Member Services at (800) 642-4168 or for hearing impaired TTY/Ohio Relay at (800) 750-0750 or 7-1-1, Monday to Friday, 7 a.m. - 7p.m. if:
- You need to ask about a drug.
- You have trouble getting a prescription filled at the pharmacy. (Please do not pay for the prescription.)
- Prescriptions are covered through Molina Healthcare’s contracted pharmacies within Ohio. Prescriptions are covered outside of the state of Ohio(out of area) for emergency or urgent services only.
- You need an interpreter to communicate with the pharmacy about getting your child’s medication.
- When your child has an emergency and need drugs, Molina Healthcare will provide you with up to a 72-hour supply of the drug.
View a list of pharmacies.
View the Preferred Drug List.
View the Preferred Drug List (PDL) Updates.
View the Durable Medical Equipment Benefit.
View the 2020 Unified Preferred Drug List (PDL) Updates (effective Sept. 1 2020).
View the 2020 Unified Preferred Drug List (PDL) Updates (effective Oct. 1 2020).
View the 2021 Unified Preferred Drug List (PDL) Updates (effective Jan. 1 2021).
View the Over-The-Counter (OTC) and Durable Medical Equipment (DME) Products List (effective July 1 2020).
View the Over-The-Counter (OTC) and Durable Medical Equipment (DME) Products List (effective Jan. 1 2021).