Benefits and Services

Welcome Molina Healthcare of Virginia members!

With your Molina Medicaid benefits, you’ll get standard benefits like:

  • Are you having trouble working due to your health condition? 

    You may be able to get a monthly check from the Social Security Administration (SSA)! This check can help you with your living costs.

    Finding out if you’re eligible takes time and the process to apply can be hard. That’s why we partner with Healthcare Financial Inc. (HFI) and their team of SSA experts to help you get the benefits you need. This service is offered to Molina Healthcare of Virginia members at no cost.

    Find out if you’re eligible to begin the process—talk to an HFI member advocate today.

    Call HFI at (833) 896-6610, Monday through Friday from 9 a.m. to 5 p.m.

    The sooner you begin, the sooner you may be approved and can start getting monthly disability checks!

    Apply for supplemental security income:
    I’m a member
    I’m a provider/case manager

    If you have any question, please call Member Services at (800) 424-4518 (TTY 711). We’re available Monday through Friday from 8 a.m. to 8 p.m. local time. 

 

Pharmacy Benefits

List of covered drugs

Molina has a list of covered drugs that we select with the help of doctors and pharmacists. This is called a preferred drug list. This list of covered drugs also includes all the drugs on the DMAS Preferred Drug List (PDL). The list tells you which drugs are covered by us and if there are any rules or restrictions on any drugs, such as a limit on the amount you can get.

To get medicines on the list of covered drugs, you need to get a prescription from your doctor first. Take the prescription to a pharmacy in the Molina network or have your doctor call it in.

Molina pays for enhanced over-the-counter (OTC) products for all members with an active prescription from a participating provider. These products can include, but are not limited to:

  • Glucosamine with or without chondroitin
  • Fish oil
  • Saliva substitute
  • Skin or wound products
  • Psyllium
  • Fleet prep kits
  • Various vitamins or combinations not covered by the Commonwealth’s Pharmacy Manual and Covered Services
 

Please review this list to find out if your drugs are covered. If you would like a paper copy of the list of covered drugs, please call Member Services and we will mail you a copy. The list may change during the year. 

If you are on a drug that is impacted by a change to the list of covered drugs, you will be notified in writing 30 days prior to the change taking effect.

If you have any questions about your medicine(s) or about your Molina pharmacy benefits, please call our Member Services team.

icon_pdf List of covered drugs -- Effective July 2023

icon_pdf List of covered drugs -- Effective October 2023

icon_pdf List of covered drugs -- Effective January 2024

icon_pdf List of covered drugs -- Effective July 2024

icon_pdf List of covered drugs -- Effective October 2024

icon_pdf List of covered drugs -- Effective January 2025

Searchable Formulary

icon_pdf Searchable Formulary 

Medical Preferred Drug List

icon_pdf Physician Administered Preferred Drug list -- updated February 2024

Reimbursement Claim Form

icon_pdf Prescription Reimbursement Claim Form -- updated December 2023

Direct Member Reimbursement (DMR)

If you have Medicaid coverage with Molina Healthcare of Virginia (and no other coverage like Medicare), DO NOT pay for any prescription drugs. Call the Member Services number (800) 424-4518 on your card if you are told to pay. If you go to an out-of-network pharmacy, you will have to pay the full cost of your prescriptions. Molina will only reimburse you for prescription medications dispensed to you while you have Medicaid coverage with Molina.

Member reimbursement happens when you ask us to pay you back for the prescription drug(s) you paid for with your own money. If you used your own money to pay for a prescription that is covered by your plan, you may request a reimbursement if any of the following happened:

  • You didn’t use your member ID card
  • You didn’t use your member ID card at an in-network pharmacy.
  • You used an out-of-network pharmacy because:

    • You needed drugs while traveling away from home and couldn’t go to your regular pharmacy
    • You were unable to get drugs in a timely manner from your regular pharmacy
    • You were forced to leave your home due to an emergency
    • The pharmacy billed the wrong plan (if you have other coverage)
    • You receive the drugs from an out-of-network pharmacy associated with an emergency department, clinic, or outpatient facility
     
  • You paid out-of-pocket for a medication when a prior authorization was in place.
  • The pharmacy billed the wrong plan (if you have other coverage)

 

Please fill out the Prescription Reimbursement Claim Form neatly and completely and attach a copy of your cash register receipt. If your prescription is a compound, please include each ingredient, dispensing facility, each ingredient cost, and prescription name. The pharmacy should help you fill out this portion. Send the completed form to the CVS Caremark address provided on the form.

Getting your medicines

For new medicines – When you get a prescription from your doctor, ask them to send it to a network pharmacy near you. You can find a list of pharmacies that work with Molina in our online provider directory. You may also take the prescription to a pharmacy that works with Molina and drop it off yourself.

For medicines you already take – If you already have medicines at a pharmacy that’s not on our list, you will need to pick a new in-network pharmacy. Once you do, simply ask the new pharmacy to get your prescription from your old pharmacy. Make sure you bring your Member ID card so you can show it to the pharmacist.

Specialty pharmacy program

Molina wants to help you get the care you need. Maybe you need to take a specialty medicine. Specialty medicines can be oral, but many times they are injected, infused, or inhaled medicines. These may need special storage or handling. Molina limits the amount of specialty drug fills to up to a 34-day supply.

CVS Specialty Pharmacy is our preferred specialty pharmacy. We’d like you to get your specialty medicine sent through the mail from CVS Specialty Pharmacy. CVS Specialty Pharmacy will work closely with you and your provider to give you what you need to help manage your condition.

Services and programs to support your needs
CVS Specialty Pharmacy makes it easy for you to get your specialty medicine with helpful services like:

  • Coaching programs to help manage your condition
  • Free delivery to your home or another address within two days of ordering
  • Supplies such as syringes and needles at no cost
  • Highly trained pharmacists and nurses available to answer any questions
  • Insurance specialists to help you get the most out of your benefits
  • Online member portal where you can request refills and learn more
 

Get started today
If you have a new prescription or if you are requesting a refill from another pharmacy, please call CVS Specialty Pharmacy to get your medicine delivered to you at no cost. If you do not want to use CVS Specialty Pharmacy pharmacy, tell the pharmacy team member at the time of the call. They will make a change that will allow you to continue to get your specialty medicine at your current pharmacy.

Contact us
Have questions? Please call CVS Specialty Pharmacy at (800) 237-2767 (TTY/TDD 711). They're available Monday through Friday from 8 a.m. to 10 p.m. local time. The pharmacy is available 24 hours a day, seven days a week for emergencies.

Mail order pharmacy program

Molina uses CVS Caremark Mail Service Pharmacy to deliver 90-day supplies of medications you take regularly to your door. This benefit is permitted for medications included on the DMAS 90-day drug list. Please call CVS Caremark Mail Service Pharmacy at (844) 285-8668 (TTY/TDD 711) to start using this service. Additional information may be accessed at https://www.caremark.com

Join CVS Caremark for quick and easy digital tools to help you manage your health.

Do you use a CVS Caremark pharmacy to fill your medications? Join CVS Caremark today to access digital tools to help you manage all your healthcare and prescription needs. You can choose free home delivery of a medication, check your refill status, research your medication coverage, and so much more.

Everything you need is available online. 

Visit our website for more information and register.

Drug recalls

List of recalled drugs

Medicare and Medicaid services

If you have Medicare and Medicaid, some of your services will be covered by your Medicare plan and some will be covered by Molina. We are your Cardinal Care Medicaid plan.

Types of services under Medicare

  • Inpatient hospital care (medical and psychiatric)
  • Outpatient care (medical and psychiatric)
  • Physician and specialist services
  • X-ray, lab work and diagnostic tests
  • Skilled nursing facility care
  • Home health care
  • Hospice care
  • Prescription drugs
  • Durable medical equipment

 

Types of services under Cardinal Care Medicaid

  • Medicare copayments
  • Hospital and skilled nursing when Medicare benefits are exhausted
  • Long-term nursing facility care (custodial)
  • Home and community-based waiver services, like personal care and respite care, environmental/home modifications and assistive technology services
  • Community behavioral health services
  • Medicare non-covered services, like some over the counter medicines, medical equipment and supplies, and incontinence products

 

For more information about these services, contact your Medicare plan, visit Medicare.gov, or call Medicare at (800) 633-4227 (TTY (877) 486-2048).

For detailed information about your benefits, please review your member handbook.

Safelink wireless phone

Some Molina members are also eligible to receive SafeLink Wireless smartphones.

There are three easy ways to enroll in the SafeLink Wireless program:

  1. Visit www.safelink.com to apply online.
  2. Print and fill out the application below mail it in.
    Safelink Wireless member application (English)
  3. Call SafeLink at (877) 631-2550.

Transportation

Do you need a ride to your healthcare appointments? Call Access2Care at (833) 273-7416 to schedule a ride. Visit our “How do I?” page to read more about how to set up a ride to your appointments.

Read these FAQs to learn more about Access2Care transportation services:

 icon_pdf Molina Healthcare Member FAQ

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