Molina Clinical Policy

For Benefit Interpretation Policies, please click here (for Marketplace only).

For Medicare, click here to access additional third-party criteria Molina uses for medical necessity decisions.

Medicaid/Marketplace Medicaid/Marketplace

Marketplace Pharmacy Policies are located here. Select your State at the top right of the page.

For Medicaid Pharmacy Policies, please review your State specific webpage via the MolinaHealthCare.com main page – select your State at the top of the page. For further questions, please contact Member Services.

 

 

 

Medicare Medicare

For Medicare Pharmacy Policies: Members, please review your State specific webpage via the MolinaHealthCare.com main page – select your State at the top of the page. For Providers, click here: Medicare Providers.

 

State Specific Sites

This page lists Corporate Molina Clinical Policies (MCPs). Please check your State’s website for policies that contain State-specific language or requirements in addition to what is listed in the Corporate policy. Applicable information is listed in the Appendix at the end of policies.