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Molina Healthcare uses a Preferred Drug List (sometimes called a PDL or a formulary), 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 (or network) and registered with the State of Utah Medicaid agency.
Prescription medications (drugs) are covered when:
- Medically necessary.
- Ordered by your doctor or another provider who has a contract with Molina Healthcare.
- Ordered or given while you are in an emergency room or hospital.
- Given while you are in a rest home, nursing home or convalescent hospital.
- Prescribed by a family planning doctor or other provider whose services do not require an approval.
- Drug is listed on the Utah Medicaid Preferred Drug List and Utah CHIP Preferred Drug List (view or download to find a drug).
- The Preferred Drug List (PDL or Formulary) is Molina Healthcare’s list of approved drugs that doctors can order for you.
- You may have up to three drug co-pays a month if you are enrolled in Medicaid.
- Some drugs are managed by the State of Utah Medicaid and not Molina (these drugs are “carved out”). For more details go to the State of Utah Medicaid Preferred Drug List.
- Specialty drugs: you are required to get some specialty drugs from preferred specialty pharmacies in Molina’s network.
- Any drugs that are not on Molina’s Preferred Drug List will require prior authorization with more information from your doctor. Your provider needs to send Molina Healthcare a request and get prior authorization before these drugs will be covered.
Molina prefers generic drugs that have proven as effective as name brand drugs. 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 doctor orders a brand name drug and there is a generic available, Molina Healthcare will cover the generic medication. If your doctor says that you must have the brand name drug instead of the generic, he/she must submit a Prior Authorization Form to Molina Healthcare’s Pharmacy Department.
Mail Service Order Form
View the Mail Service Order form to receive a 90-day supply of certain formulary drugs. These drugs are indicated as “90 day program” next to the drug tier status on the Molina Healthcare Medicaid Formulary.
Prescription Reimbursement Claim Form
Please submit to CVS Caremark as shown on the Prescription Reimbursement Claim form.
If you have questions or need help getting your drugs
Call Member Services at (888) 483-0760, Monday to Friday, 9:00 a.m. - 5:00 p.m. (TTY: 711) if you:
- Need to ask about a drug.
- Have trouble getting a prescription filled at the pharmacy.
- Need an interpreter to communicate with the pharmacy about getting your medication.
- Need a paper copy of the Drug List sent to you.
Call your doctor if you need an emergency supply and you’re out of your medication. We’re here to work with your doctor to get the care you need.
Note: Prescriptions are covered outside of the State of Utah (out of area) for emergency or urgent services only.
Other helpful links:
Pharmacy Questions & Answers: View answers to the questions we're asked most about pharmacy benefits.
Find a Provider: Use our online tool to find a doctor, hospital or facility in your network.