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Drug Formulary

pdf icon 2019 Medi-Cal Drug Formulary

To access the Prior Authorization Criteria Guidelines and the Medication Prior Authorization Request Form, please go to:

Frequently Used Forms                   
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Prescription Drugs & Medication

Molina Healthcare covers all medically necessary Medicaid-covered medications. We also use a preferred drug list (PDL). These are the drugs that we prefer our providers to prescribe.

Over-the-Counter drugs

Molina Healthcare also covers the over-the-counter drug listed on our PDL for our members. The member needs a prescription for over-the-counter drug for it to be covered by Molina.

Prior Authorization

Some drugs require a prior authorization (PA) to explain to us why a specific medication or a certain amount of a medication is needed. We must approve the request before the member can get the medication. Reasons why we may prior authorize a drug, include but is not limited to:

  • There is a generic or pharmacy alternative drug available
  • The drug can be misused/abused
  • There are other drugs that must be tried first

Some drugs may also have quantity (amount) limits and some drugs are never covered, such as drugs for weight loss. Drugs for erectile dysfunction, infertility, cosmetic purposes also are not covered. For a complete list of non-covered/excluded drugs, please see our preferred drug list document, under Non-covered/Excluded Medications.

Generic Drugs

Molina Healthcare requires the use of generic drugs if they are available. If you believe that it is medically necessary for the member to have a brand name drug, you may submit a prior authorization request to Molina Healthcare. Molina Healthcare will review the request and determine whether to approve the brand name medication.

Our PDL and list of medications that require prior authorization can change, so it is important for you or your patient to check this information when your patient needs to fill or refill a medication.


 

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