Molinalogo

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.

Preferred Drug List Changes

• 1Q 2025 PDL Updates: Humira Biosimilars—Effective March 21, 2025
• 1Q 2025 PDL Updates—Effective March 21, 2025
• 1Q 2025 PDL Updates: Glucose Monitors and Supplies—Effective March 21, 2025
• 1Q 2024 PDL Updates—Effective January 1, 2024
• 4Q 2023 PDL Updates—Effective October 6, 2023
• 3Q 2023 PDL Updates—Effective July 1, 2023
• 2Q 2023 PDL Updates—Effective April 1, 2023
• 1Q 2023 PDL Updates—Effective January 1, 2023
• 4Q 2022 PDL Updates—Effective October 1, 2022
• 3Q 2022 PDL Updates—Effective July 1, 2022
• 2Q 2022 PDL Updates—Effective April 1, 2022

 

NEW! Preferred Drug List Search Tool

Use our preferred drug list search tool to:

• Search for your medicine by name or class.
• Find generic alternatives to your medicine.
• See if your medicine has quantity limits, has age limits, or requires Prior Authorization.
• Searchable Formulary

 

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:

• 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 and infertility also are not covered.

NOTE: As of April 1, 2023, Evolent (New Century Health or NCH) performs Oncology services on behalf of Molina Healthcare for pharmacy benefit medications only when they are submitted as part of a combined regimen for oncology. If you have a request that includes both medical and pharmacy benefit drugs, submit your Prior Authorization request directly to Evolent via the NCH provider portal: my.newcenturyhealth.com or you may call Evolent at (888) 999-7713.

 

Over-the-Counter Drugs

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

 

Pharmacy PA Forms

• Illinois Medicaid Synagis Authorization Form
• Pharmacy Prior Authorization Form
• Medications for Treatment of Chronic Hepatitis C Prior Authorization Form
• Uniform Illinois Medicaid Pharmacy Prior Authorization Form

 

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.

 

Questions?

Call Provider Services at (855) 866-5462.

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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