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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

• 2Q 2022 PDL Updates—Effective April 1, 2022
• 3Q 2022 PDL Updates—Effective July 1, 2022
• 4Q 2022 PDL Updates—Effective October 1, 2022
• 1Q 2023 PDL Updates—Effective January 1, 2023

 

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.

 

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.

 

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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