Prescription Drugs
The drug formulary is a list of covered drugs. Molina Dual Options will generally cover any prescription drug listed in our formulary as long as:
- The drug is medically necessary.
- The prescription is filled at a Molina Dual Options network pharmacy and other plan rules are followed.
Drug Formulary
To view the Molina Dual Options Drug Formulary for your plan, please click below.
Drug Formulary Search
Please note: Members can contact the plan for a printed copy of the most recent list of drugs or view the link above. You can contact our Pharmacy team at (855) 735-5831, TTY 711, Monday - Sunday, 8:00 a.m. to 8:00 p.m. local time.
Can the Formulary Change?
- We may add or remove drugs from the formulary during the year. View
Drug Formulary Updates. - Changes in the formulary may affect which drugs are covered and how much you will pay when filling your prescription.
- If we remove drugs from the formulary, or add prior authorizations, quantity limits and/or step therapy restrictions on a drug, and you are taking the drug affected by the change, we will notify you of the change at least 30 days before the date that the change becomes effective.
- If a drug is removed from our formulary because the drug has been recalled from the market, we will not give 60 days notice before removing the drug from the formulary. Instead, we will remove the drug from our formulary immediately and notify members about the change as soon as possible.
Learn More About Your Pharmacy Benefits by Clicking on an Option Below:
Prior Authorization
This is a list of drugs that requires certain criteria to be met before a drug is covered. For example, diagnosis, lab values, or previous treatments tried and failed.
Step Therapy
Certain cost-effective drugs must be used before other more expensive drugs are covered. For example, certain brand-name medications will only be covered if a generic alternative has been tried first.
2024 Medicare Part D Drug (J-Code) Step Therapy
2025 Medicare Part D Drug (J-Code) Step Therapy
2024 Exceptions for Out-of-Network (OON) Coverage
2025 Exceptions for Out-of-Network (OON) Coverage
Information on when Molina Dual Options will reimburse members for coverage charges incurred at out-of-network pharmacies.
2024 Transition Policy
2025 Transition Policy
Information for new members in our plan who are taking drugs that aren't on our formulary or that are subject to certain restrictions.
2024 Medication Safety Policy
2025 Medication Safety Policy
Managing Your Medications Is Important To Us.
Molina Dual Options has established quality assurance measures and systems in order to make sure that medications are used in a safe and effective manner.
Click here to view Prescription Drug forms.
How do members get care?
- You can visit your local pharmacy to fill your prescription.
- You can also complete a Mail Service Order Form.
For more information, you can call Member Services.
Plan Materials
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*Printed copies of information posted on our website are available upon request.
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