Pharmacy
For Pharmacy forms, please go to our Forms page.
- VA Medicaid 90-Day Drug List Update
The Department of Medical Assistance Services (DMAS) implemented a new permanent policy allowing coverage of a maximum 90-day supply of many maintenance drugs will be implemented on 10/1/2021. The list of eligible maintenance drugs includes many highly utilized medications on the DMAS Preferred Drug List, which members typically receive for long-term therapy. Members will be eligible for this policy after receiving two 34-day or shorter fills of drugs on this list. This new maintenance list is not all inclusive. If a member’s medication is not on the maintenance list, they may receive a maximum 34-day supply of their prescriptions.
The 90-day supply drug list may be accessed at https://www.virginiamedicaidpharmacyservices.com/provider/external/medicaid/vamps/doc/en-us/VAMPS_90-day_supply_list.pdf.
- Preferred Drug List
Molina Healthcare has a list of covered drugs that are selected by us with the help of a team of doctors and pharmacists.
This list of covered drugs also includes all the drugs on the DMAS Preferred Drug List (PDL). The list includes drugs covered by us and tells you if there are any rules or restrictions on them, such as a limit on the amount a member can get.
Molina will pay up to $50 per quarter for select over-the-counter (OTC) products for members with an active prescription from a participating provider. These products can include:
- Vitamins
- Cough and cold medicines
- Antihistamines
- Antacids
- Artificial tears
- Topical antibiotics
- Antifungals
- Gastrointestinal medicines
Please review this list to find out what drugs are covered by Molina. If you would like a paper copy of the list of covered drugs, please call us and we will mail a copy to you. Please be aware that this list may change throughout the year.
- Commonwealth Coordinated Care Plus (CCC Plus): (800) 424-4524
- Medallion 4.0: (800) 424-4518
Preferred insulin pens/needles, Self-Blood Glucose Monitoring (SBGM) and suppliesMolina Healthcare is an existing plan sponsor with CVS Caremark®. Here is a list of preferred diabetic supplies:
Meters
These meters are preferred but are only covered through a free manufacturer program with the following point-of-sale processing information:
- True Metrix Blood Glucose Test Strip
- True Metrix Meter Kit w/Device
- True Metrix Meter Kit w/Device
- True Metrix Air Glucose Meter Kit w/Device
- ReliOn True Met Air Glucose Meter Kit w/Device
- True Metrix Air Glucose Meter Device
- True Metrix Air Glucose Meter Kit w/Device
BIN: 018844
PCN: 3F
ID: TRPT5023493
Subgroup: FVTRUEPORT50
Help desk phone: (855) 282-4888Test strips
- ReliOn True Metrix Test Strips
- True Metrix Blood Glucose Test
Pens/needles
- TechLITE Insulin Syringe
- TechLite Pen Needles
- TRUEplus 5-Bevel Pen Needles
- TRUEplus Insulin Syringe
- TRUEplus Pen Needle
If you prescribe a drug that is impacted by a change to the list of covered drugs, you will be notified in writing 30 days prior to the change taking effect.
List of covered drugs -- Effective January 2023
- Drug Recalls
- Molina Specialty Pharmacy Program
Molina Healthcare is committed to providing you and your patients with access to quality services and cost-effective prescription drugs. CVS Specialty Pharmacy provides specialty pharmacy services to your patients.
What this means to you and your patients
Prescription drug requests for specialty medications for Molina members need to be submitted to CVS Specialty Pharmacy for fulfillment. You or your patient may call CVS Specialty Pharmacy at (800) 237-2767 to start using CVS Specialty Pharmacy so they can continue to provide your medication.
Our current Prior Authorization (PA) process will stay the same. Patients with an existing authorization will not need to request a new PA until the current authorization has expired.
Services and programs to help patients stay on your treatment plan
With CVS Specialty Pharmacy, your patients have access to the following specialty services:
- Insurance specialists to help get the most out of benefits
- Coordination of medication, including delivery to your office or patient’s home
- Important supplies at no additional cost, such as syringes and needles
- Highly trained pharmacists and nurses available toll-free to answer any questions
- Online member portal to request refills and learn more
- Access to community resources
To submit a prescription, or if you have questions, please contact CVS Specialty Pharmacy at (800) 237-2767.
- J Code Prior Authorization Changes
Please refer to the Code LookUp Tool to determine J Code prior authorization requirements effective July 1, 2022.
See a list of prior authorization requirement changes effective May 1, 2021See a list of prior authorization requirement changes effective October 1, 2020
These medications require prior authorization effective September 1, 2020
Please refer to the prior authorization list for a complete list of medications and services that require prior authorization.
- Biosimilar Program
We support a biosimilar UM program that includes select HCPCS (e.g., JCodes) that have biosimilar products.
A biosimilar product is highly similar to, and has no clinically meaningful differences in safety, purity and potency (safety and effectiveness) from, an existing FDA-approved reference product. A manufacturer developing a proposed biosimilar demonstrates that its product is highly similar to the reference product by extensively analyzing (i.e., characterizing) the structure and function of both the reference product and the proposed biosimilar. A manufacturer must also demonstrate that its proposed biosimilar product has no clinically meaningful differences from the reference product in terms of safety, purity and potency (safety and effectiveness).
JCode utilization management medical necessity requests for reference products that have a biosimilar product will require a trial/failure of the respective biosimilar product. Patients with an existing authorization or are already on a reference product will not be required to try/fail a biosimilar product. Please refer to your Provider Manual for additional information on service authorization requests.
Additional information on biosimilars may be accessed at U.S. Food and Drug Administration Biosimilar website at https://www.fda.gov/drugs/therapeutic-biologics-applications-bla/biosimilars.