Prescription medications are covered when:
- Medically necessary.
- Ordered by your provider who has a contract with Molina Healthcare. Check Find a Provider to see if your provider is contracted with Molina Healthcare.
- The drug is listed on the Molina Healthcare Drug List (Formulary).
- The Drug List (Formulary) is Molina Healthcare’s list of approved drugs that providers can order for you.
- Received through a pharmacy that is in the Molina Healthcare Pharmacy Network.
- 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.
Note: Certain medications need prior approval by Molina Healthcare. Your provider needs to send Molina Healthcare a request and get prior authorization before these drugs will be covered.
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 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 you must have the brand name drug instead of the generic, he/she must submit a prior authorization request to Molina Healthcare’s Pharmacy Department.
It tells you what you need to know about your Molina Healthcare Apple Health (Medicaid) coverage. Read here.
How do members get care?
Call Member Services if:
- You have questions about whether a drug is covered.
- You have trouble getting a prescription filled at the pharmacy. (Please do not pay for the prescription.)
- You need an interpreter to communicate with the pharmacy about getting your medication.
Prescriptions are covered through Molina Healthcare’s contracted pharmacies in Washington State. Prescriptions are covered outside of Washington State (out of area) for emergency or urgent needs only. When you have an emergency and need drugs, your pharmacy can provide you with up to a 72-hour supply of the drug.