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Medical Policy and Clinical UM Guidelines

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Pharmacy information

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Pharmacy Information for Providers 
Effective July 1, 2017, the West Virginia Medicaid Fee for Service Program will provide retail point of sale (POS) pharmacy services for all Medicaid Managed Care members. Prior authorization obtained from the managed care organizations (MCOs) will be transferred to the Molina system and will be honored for the amount of time through which they were issued by the MCOs. 
To obtain a prior authorization after June 30, 2017, for retail pharmacy POS services, please contact the Rational Drug Therapy Program by fax at 1-800-531-7787 or by phone at 1-800-847-3859. 
Where to Get Prescriptions Filled 
Medicaid members should experience no disruption in service and can continue to take their prescriptions to the pharmacy of their choice. 
Prior Authorization  
To obtain a prior authorization after June 30, 2017, for retail pharmacy POS services, please contact the Rational Drug Therapy Program by fax at 1-800-531-7787 or by phone at 1-800-847-3859. 
To obtain a prior authorization for medical injectables, please see the Office-Based Injectables section below. 
Office-Based Injectables 
Drugs requiring the assistance of a medical professional (office-based injectables) are not covered under the pharmacy benefit. Medically necessary office-based injectables are covered under the major medical benefit. Please refer to the Member Handbook for more details on medical coverage. 
Content Forms  
Important Toll-free Contact Numbers 
Customer Care Center: 1-800-782-0095
Medical Injectable Prior Authorization Requests:

Phone: 1-877-375-6185 or Fax: 1-844-487-9290.

All Other Prior Authorization Requests:

Phone: 1-800-847-3859 or Fax: 1-800-531-7787

Customer Service TTY line: 1-866-368-1634
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