Drug List
To view the Molina Healthcare of Idaho Medicaid Formularies, click below:
SureScript Real-Time Prescription Benefits
The following documents provide information pertaining to the CVS SureScript Real-Time Benefits now available to providers.
Prescription Claims Processor
Molina has selected CVS Health as the Pharmacy Benefits Manager (PBM) company to manage the prescription benefit for Molina members.
- Questions on processing claims, formulary status or rejected claims may be directed to the CVS Health Help Desk at 877-775-5635 (select pharmacy option).
- Membership and eligibility questions may be addressed by calling Molina Member Services at (844) 809-8445.
- Provider-related questions may be addressed by calling Molina Provider Services at (844) 808-1383.
Pharmacies who wish to submit a Maximum Allowable Cost (MAC) appeal to CVS, can do so by logging into the CVS pharmacy portal: https://rxservices.cvscaremark.com/. Additionally, the MAC Appeals Process User Guide can be used to guide pharmacies through the process of submitting MAC appeals to CVS.
- MAC prices are subject to frequent change based on several factors such as state requirement and CVS Health's best understanding of the marketplace and product availability.
- Molina utilizes the MAC appeal report to request status updates regarding pharmacies who have submitted an appeal. An uptick in the number of appeals, as well as specific NDCs, may require further investigation by the Molina pharmacy team.
- For any questions regarding MAC appeals, please contact CVS Health by:
- Emailing the CVS Network Services team at MACInquiries@CVSHealth.com or
- Calling 1-847-559-3977 or
- CVS Pharmacy Help Desk at 877-775-5635 (select pharmacy option, not member)