Pharmacy
For Pharmacy forms, please go to our forms page
Preferred Drug List
Please familiarize yourself with the Preferred Drug List as you prescribe medications for Molina Healthcare beneficiaries. Thank you for your cooperation.
Preferred Drug List. Also available is the machine-readable JSON file
Prior Authorizations
Molina’s decisions are based upon the information included with the PA request. Clinical notes are recommended.
Pharmacy Prior Authorization Form
Real-Time Prescription Benefits Access and Onboarding Handbook
Real-Time Prescription Benefits Information at the Point of Care
Prior Authorization Criteria:
Enzyme Replacement Therapy for Gaucher Disease_Cerezyme_Elelyso_Vpriv |
Enzyme Replacement Therapy for Lysosomal Storage Disorders_Aldurazyme, Naglazyme |
Step Therapy
In some cases, Molina Healthcare requires members to first try certain drugs to treat their medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat the member’s medical condition, Molina Healthcare may not cover Drug B unless you try Drug A first. If Drug A does not work for the member, Molina Healthcare will then cover Drug B.