Preferred Drug List (PDL):
There may be times when your practitioner/provider prescribes a medication for you. The prescriptions for your medications can be filled at most retail pharmacies.
Molina Healthcare uses a special list of drugs. It is called a Drug List (Preferred Drug List). Molina Healthcare's list of drugs can be prescribed for you by your practitioner/provider.
- This list is given to PCPs and specialists. Your PCP can tell you if the drug you need is on the list. If the drug is not on the Drug List (Preferred Drug List), your PCP has to get approval.
- Your PCP must submit a prior authorization form to Molina Healthcare. The prior authorization form should explain why you need a drug that is not on the list.
Exceptions to Rejected Medications
- Your doctor can ask Molina Healthcare to cover a drug that is not on this list. This is called an “exception”. Your doctor can ask for a prior authorization. They ask Molina Healthcare for the prior authorization.
- If your doctor’s prior authorization request for an exception is not approved, you have a right to appeal that decision. You have a right to get another review. You will get a denial letter from Molina Healthcare. Your doctor will get a denial letter from Molina Healthcare. The letter will tell you how to ask for an appeal.
Members Getting an Exception to the Preferred Drug List (PDL)
Drugs not listed on the Preferred Drug List are called non-preferred drugs. For non-preferred drugs, you have the following options:
- You can ask your doctor to order a similar drug that is listed on the PDL.
- You can ask your doctor to submit a prior authorization request so your non-preferred drug may be covered by your benefit.
- You can start the request for exception for a non-preferred drug.
How do Members Get Care?
If you have questions about the Drug List (Preferred Drug List) or prior authorizations, call Molina Healthcare at (855) 882-3901.
The pharmacy can give you a refill on your medication. You can get a refill if your doctor has ordered one. The pharmacy cannot refill your medication more than five (5) days before the refill date. They cannot refill it before three fourths (3/4) of your medication has been used.
What is a prior authorization request?
A prior authorization request is how your doctor may ask for a particular medication to be covered for your use. If the request is approved, your prescription cost will be paid by Molina Healthcare. If the request is not approved, your doctor may choose a different medication or you can appeal the decision.
What is a Preferred Drug List?
Molina Healthcare of South Carolina uses a Preferred Drug List, which lists the drugs that are covered by the health plan. This list was carefully created by a group of pharmacists and physicians. View the Molina Preferred Drug List.
Why must I use Preferred Drug List drugs?
Preferred Drug List drugs were selected because they are quality medications that are a good value. They are often the best choices to treat medical and behavioral conditions.
What if I have a prescription for a non-Preferred Drug List drug?
You may ask your doctor to switch to another medication that is on the Preferred Drug List and covered by your health plan, or your doctor can submit a prior authorization request to Molina Healthcare.