Prior authorizations in California
Providers can find details about Molina’s prior authorization (PA) process, methods for submitting requests, procedures for denials and peer-to-peer reviews, how to access forms and how to contact our team.
Important update for providers:
Starting 2/1/26, providers must submit medical benefit PA requests through the Availity provider portal, as Molina no longer accepts fax submissions.
Continue to follow the current pharmacy submission processes for pharmacy benefit PA requests. Do not submit pharmacy benefit PA requests through the Availity provider portal.
Services prior authorization
Office visits to participating providers (PAR) and referrals to network specialists do not need PA. Emergency services also do not require authorization.
Molina requires PA for certain services. See which services need PA with the prior authorization lookup tool. Providers can request and manage authorizations via the Availity provider portal.
Pharmacy prior authorization
Molina attempts to provide appropriate and cost-effective drug therapy to all members covered by the Molina pharmacy program. If a member requires medication that does not appear on the formulary, the physician can make a request for a non-preferred medication.
Click here for more information on pharmacy PA.
Medicaid plans
As of January 1, 2022, pharmacy benefits are administered by Medi-Cal Rx and its Pharmacy Benefit Manager directly. The health plan does not administer them. Please see the Medi-Cal Rx site for Medicaid pharmacy benefit details. Clinician-administered drugs are covered by the health plan through the medical benefit (“buy-and-bill”), although, some medications may still be carved out to the fee-for-service program.
Individual and family plans
Molina manages prescription drug benefits through CVS/Caremark. Outpatient drugs on Molina's preferred drug list (PDL) are covered when applicable utilization management criteria are met, while medications not on the PDL need prior authorization for approval.