Getting My Medicine
Molina Healthcare uses a Preferred Drug List (PDL) for Medicaid, which is a list of covered prescription drugs that is reviewed, approved and maintained by a team of doctors and pharmacists at the State of Florida. They also determine coverage requirements such as prior authorization as applicable. You must get your prescriptions from a pharmacy that is part of the Molina plan.
Generic drugs must be used when listed on the PDL. There are drugs that may have a limit on how much you can get at one time and its strength. Sometimes you have to try other medications first before we approve a drug. This is called Step-Therapy.
Your doctor knows about:
- The drugs on the Preferred Drug List.
- The drugs that need prior approval.
- How to process special requests.
Florida Medicaid Preferred Drug List (PDL)
If you are a member, please click here for the Preferred Drug List.
If you have Medicaid coverage with Molina Healthcare of Florida (and no other coverage like Medicare), do NOT pay for any prescription drugs. Call Member Services if you are told to pay.
Member reimbursement happens when you ask us to pay you back for prescription drug(s) that you paid for with your own money. If you used your own money to pay for a prescription that is covered by your plan, you may request a reimbursement if any of the following happened:
- You didn’t use your member ID card
- You used an out-of-network pharmacy because:
- You needed drugs while traveling away from home and couldn’t go to your regular pharmacy
- You were unable to get drugs in a timely manner from your regular pharmacy
- You were forced to leave your home due to an emergency
- The pharmacy billed the wrong plan (if you have other coverage)
- You receive the drugs from an out-of-network pharmacy associated with an emergency department, clinic or outpatient facility
Out-of-network coverage is only available for the reasons listed above. If you go to an out-of-network pharmacy, they won’t be able to submit the claim directly to us. You will have to pay the full cost of your prescription and then submit a request. If out-of-network conditions are met, only then will you get your money back.
Do not sent requests to get your money back for drug claims that were already paid by your health plan. If you have further questions about drug member reimbursement, please call Molina Member Services at <1-866-472-4585 (TTY 711)>.
Your doctor will get prior approval for the drugs that need it. Your doctor may want to give you a drug that is not on the state of Florida PDL. Your doctor will ask an approval through Molina's Pharmacy Department. We will reply to your doctor in 24 hours. If it is the weekend, we will reply the next working day. If the request is approved, we will tell your doctor. If a request is denied, a letter will be mailed to you and your doctor. The letter will tell you the reason for the denial. The letter will let you know how to appeal.
You may be taking a drug that is no longer on our state of Florida PDL. Your doctor can ask us to keep paying for this drug by requesting a prior approval. The drug must be safe and help you with your medical problem.
If your drug is lost, stolen or damaged, you might need a prior authorization to get a refill sooner than expected.
There are drugs that are not covered, for example some drugs for weight loss or cosmetic purposes. You may want to know the list of drugs that are covered. Call Member Services.
You may call Member Services to get the following:
- A copy of the Preferred Drug List
- Information about drugs
- Find out if a drug is covered
- Find out how to appeal a decision
Your doctor will work with Molina to decide which drugs are best for you.
Molina Healthcare has contracts with certain pharmacies. You must get your drugs at one of these pharmacies. Click to Find a Pharmacy closest to you.
Mail Service Pharmacy
Molina wants to offer a time saving way to get your medicine. You can get a thirty-four (34) day supply on most drugs and up to one hundred (100) day supply on certain drugs. This is a great benefit. It is easy and can save you time. You don’t have to go to the pharmacy every month. If you want more info, call the Member Services Department. They can help you sign up.
Getting an exception to the PDL
Drugs not listed on the PDL are called non‐formulary drugs. For non‐formulary drugs, you have the following options:
- You can ask your physician to order a similar drug that is listed in the PDL.
- You can ask your physician to request an exception so your non‐formulary drug can be covered by your benefit.
- You can start the request for exception for a non‐formulary drug.
- If you want to start the exception process, you can call Member Services or complete the form below.
Member Exception Form
Statewide Medicaid Managed Care (SMMC) Program Over-the-Counter Benefit (OTC)
Molina Healthcare offers a $25.00 over-the-counter (OTC) benefit per household per month. This is for specific over-the-counter items purchased at a pharmacy that is part of Molina. To get more info, call our Member Services Department at <1-866-472-4585 (TTY 711)>.
Click here to go to the OTC website.
Molina will not pay for some drugs prescribed to a child under the age of (13), without a signed consent form from the parent or guardian. Your doctor must keep a copy of the form in your child’s medical record. You or the doctor will need to give the pharmacy the signed form with a copy of the prescription.
The pharmacy will not fill this medicine for your child without the completed form. A new form must be given to the pharmacy with every new prescription.
If you have any questions about these drugs, please ask your doctor. If you want to know the list of medicines that must have a consent form, call Member Services.
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