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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_by_category_20240701.pdf.

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
  
  

Searchable Formulary 

Formulary search tool

Machine-readable formulary

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.

• Cardinal Care Managed Care: (800) 424-4518

Preferred insulin pens/needles, Self-Blood Glucose Monitoring (SBGM) and supplies

Molina Healthcare is an existing plan sponsor with CVS Caremark®. Here is a list of preferred diabetic supplies:  

Meters

Trividia Health Billing Information

BIN: 018844

• 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
  
  

• ReliOn True Metrix Test Strips
• True Metrix Blood Glucose Test
  
  

• TechLITE Insulin Syringe
• TechLite Pen Needles
• TRUEplus 5-Bevel Pen Needles
• TRUEplus Insulin Syringe
• TRUEplus Pen Needle
  
  

Important Changes to our Specialty Pharmacy Network

Effective January 1, 2025, Molina Healthcare of Virginia is implementing important changes to our Specialty Pharmacy Network. This will impact patients with complex and chronic conditions. We will inform affected members and prescribers about the process for transferring specialty prescriptions to a pharmacy included in our updated network.

Molina administers a Specialty Pharmacy Management Program that provides high-quality, cost-effective care to our members with complex and chronic conditions.Our network of specialty pharmacies is selected based on factors such as experienced clinical support, including medications, onboarding process, and personalized care management.

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.

According to Senate Bill 1538 (S.B. 1538) requires Virginia Medicaid including Medicaid Managed Care Organizations to reimburse pharmacists for any service provided under a collaborative agreement or statewide protocol.

Below are the steps for Pharmacists to get credentialed and contracted with Molina Healthcare (MHI). 

• Pharmacists must first enroll with Virginia Medicaid as a provider through the Provider Services Solution (PRSS) portal at https://virginia.hppcloud.com/.
• Once enrolled with Virginia Medicaid, send an email to Molina Healthcare Provider Network team at MCCVA-Provider@MolinaHealthcare.com and request to start the contracting and credentialing process with Molina Healthcare (MHI).
• MHI will send you the required documentation to be completed which also may be accessed at https://www.molinahealthcare.com/-/media/Molina/PublicWebsite/PDF/Providers/va/Forms/VA-ALL-PF-11460-22-VA-Guide-to-Prv-Forms-FINAL_508c.pdf.
  • Provider Information Update Form (Section A only for new providers)
  • W9
  • Attachment D: Services Provided Virginia
  • Americans with Disabilities act (ADA) Form: Virginia
• You will also need to register with CAQH Proview at https://proview.caqh.org/pr and complete all profile questions to register. Please indicate that you are authorized to access Molina Healthcare data.
• Please submit the required documentation in #3 to MCCVA-Provider@MolinaHealthcare.com.
• Once all the required documentation is submitted, MHI will send a provider contract for execution and return to MHI.
• Once contracting and credentialling approved by MHI, the MHI Provider Relations will outreach you to arrange provider orientation.
• Pharmacist can submit claims to MHI.
  
  

The American Rescue Plan Act (ARPA) expired on October 1, 2024. As such, Molina Healthcare of Virginia no longer covers COVID-19 at-home test kits under the pharmacy benefit. Rapid COVID-10 tests and Polymerase chain reaction (PCR tests) COVID-19 tests will be covered by Medical Providers, Federally Qualified Health Centers, and Clinics.

 New Standard COVID Vaccine FAQ 2024-2025

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