For more information on pharmacy prior authorization.
Important update for providers:
Starting 2/1/26, providers must submit medical benefit PA requests through Availity Essentials, as Molina no longer accepts fax submissions. Continue to follow the current pharmacy submission processes for pharmacy benefit PA requests; do not submit these through Availity Essentials.
Service Prior Authorizations
Office visits to participating (PAR) providers and referrals to network specialists do not need Prior Authorization (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 Availity Essentials
Pharmacy Prior Authorizations
Molina manages prescription drug benefits through CVS/Caremark. Outpatient drugs on Molina's preferred drug list (PDL) are covered, while medications not on the PDL need prior authorization for approval.