Prior Authorizations in New York
Providers can find details about Molina’s prior authorization (PA) process, methods for submitting requests, procedures for denials and peer-to-peer reviews, as well as how to access forms and 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 these through the Availity provider portal.
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 the Availity provider portal.
Pharmacy Prior Authorizations
Medicaid (MMC, HARP)
As of April 1, 2023, pharmacy benefits for Medicaid members are administered by New York state’s NYS Medicaid Pharmacy Program (NYRx) and its Pharmacy Benefit Manager directly. The health plan does not administer them. Please see the NYRx website for pharmacy coverage details and Prior Authorization procedures.
New York Essential Plan & New York CHP
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.
For more information on pharmacy prior authorization.