Table of Contents
What is a formulary in a health insurance plan?
A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.
In what circumstances can the plan make a formulary exception for a non covered prescription?
For formulary exceptions, the prescriber’s supporting statement must indicate that the non-formulary drug is necessary for treating an enrollee’s condition because all covered Part D drugs on any tier would not be as effective or would have adverse effects, the number of doses under a dose restriction has been or is …
What is non formulary exception?
Criteria – Medicare Part D NON-FORMULARY EXCEPTION CRITERIA FOR APPROVAL. 1. The member must have tried at least three alternative formulary drugs that have a similar. mechanism of action as the requested drug AND the member either did not respond to or did not. tolerate the formulary alternative drugs.
What is a prescription exception?
An exception procedure can be used by prescribers and patients to request coverage for drugs that are not included on a plan’s drug formulary. Through this administrative process, a plan can agree to cover medically necessary nonformulary drugs on a case-by-case basis.
Does Molina Healthcare cover over-the-counter (OTC) 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. Some drugs require a prior authorization (PA) to explain to us why a specific medication or a certain amount of a medication is needed.
Does Molina Healthcare require the use of 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.
Does Molina Healthcare cover erectile dysfunction drugs?
Drugs for erectile dysfunction and infertility also are not covered. Illinois Medicaid Synagis Authorization Form. 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.
How can I get Molina Healthcare faster?
To receive faster service, we encourage members to use our web portal at mymolina.com or to use our mobile app, Molina Mobile. Healthcare providers can use provider.molinahealthcare.com for service. Make a payment for your insurance. Learn more. Learn more. We are hiring! Join the Molina Healthcare family today.