Drug Formulary

2026 Molina Medicare Complete Care (HMO D-SNP)

 2026 Molina Dual MI Coordinated Health (HMO D-SNP) - Macomb and Wayne

 2026 Molina Dual MI Coordinated Health (HMO D-SNP) - Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, and Van Buren

 2026 Molina Medicare Complete Care (HMO D-SNP)

 2026 Molina Dual MI Coordinated Health (HMO D-SNP)

2026 Prior Authorization Grid

2026 Step Therapy Grid

 2026 Medicare Part D Drug (J-Code) Step Therapy Grid

 Request for Medicare Prescription Drug Coverage Determination

 Request for Redetermination of Medicare Prescription Drug Denial

 Direct Member Reimbursement Form

 

Labeler Reference for NDCs included under the Medicaid Drug Rebate Program

Labeler Reference for NDCs included under the Medicaid Drug Rebate Program

MHP Monthly MDRP Labeler List

 

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