Molina Healthcare Coverage for
Health Exchange
Managed Medicaid
Medicare
Frequently Asked Questions (FAQ)
Yes, Molina Healthcare requires prior authorization for Tremfya. Providers must submit documentation of the patient's diagnosis and, under some plans, previous treatments tried.
Some Molina Healthcare plans require step therapy in order to cover Tremfya, necessitating the trial of alternative treatments such as methotrexate first. Step therapies vary based on the plan and indication. Providers should document these trials and outcomes when submitting prior authorization requests.
Common coverage restrictions for Tremfya under Molina Healthcare include standard prior authorization requirements, and for some plans, specific step therapies. These restrictions can delay access if documentation is incomplete or if alternative therapies have not been tried. Ensure all criteria are met to facilitate patient access.