Drug Formulary

To view the Molina Healthcare of Utah Medicaid/CHIP Drug List(s), click below:

icon UT Medicaid Preferred Drug List
icon UT Medicaid Searchable Formulary

icon UT CHIP Preferred Drug List
icon UT CHIP Searchable Formulary

icon UT Medicaid/CHIP Medical Preferred Drug List


SureScript Real-Time Prescription Benefits 

The following documents provide information pertaining to the CVS SureScript Real-Time Benefits now available to providers.

Prescription Claims Processor

Molina has selected CVS Health as the Pharmacy Benefits Manager (PBM) company to manage the prescription benefit for Molina members.

  • Questions on processing claims, formulary status or rejected claims may be directed to the CVS Health Help Desk at (800) 551-5681

    (select pharmacy option).

  • Membership and eligibility questions may be addressed by calling Molina Member Services at (888) 483-0760.

  • Provider-related questions may be addressed by calling Molina Provider Services at (855) 322-4081.

 

Pharmacies who wish to submit a Maximum Allowable Cost (MAC) appeal to CVS, can do so by logging into the CVS pharmacy portal: https://rxservices.cvscaremark.com/. Additionally, the MAC Appeals Process User Guide can be used to guide pharmacies through the process of submitting MAC appeals to CVS.

  • MAC prices are subject to frequent change based on several factors such as state requirement and CVS Health's best understanding of the marketplace and product availability.
  • Molina utilizes the MAC appeal report to request status updates regarding pharmacies who have submitted an appeal. An uptick in the number of appeals, as well as specific NDCs, may require further investigation by the Molina pharmacy team.
  • For any questions regarding MAC appeals, please contact CVS Health by:
    • Emailing the CVS Network Services team at MACInquiries@CVSHealth.com or
    • Calling 1-847-559-3977 or
    • CVS Pharmacy Help Desk at 1-800-551-5681 (select pharmacy option, not member)

 

Pharmacy FAQ

  • When Will I Receive a Decision for a Drug Prior Authorization Request
    • All pharmacy benefit requests will be decisioned within 24 hours after all required information is received
    • Medical Benefit Drug standard or non-urgent authorization requests will be decisioned no later than two weeks after all required information is received
    • Medical Benefit Drug expedited or urgent requests will be decisioned within 72 hours after all required information is received
    • Your office will be faxed a copy of the approval or denial letter that is addressed to the member
    • If more information is requested from our medical reviewers, your office will be faxed a letter titled "Notice of Insufficient Information". This letter will give the details for what additional information needs to be submitted by the provider office
    • The definition of an expedited or urgent request should be used when the requested treatment is required to prevent serious deterioration of the member's health or could jeopardize the member's ability to regain maximum function
      • Requests outside of this definition should be submitted as standard or non-urgent