Does Molina Cover TRT? What Its August 2026 Policy and Three State Lists Show
TRT Provider Guide · Last verified: (sources checked November 9, 2026; the Marketplace drug lists we opened are current as of October 1, 2026, and Molina’s Testosterone policy C2270-A is effective August 30, 2026) · Editorial research
Last updated: .
TRT Provider Guide is an independent decision resource for testosterone replacement therapy care. We may earn a commission if you use the tracked links to Male Excel or Hone on this page. That does not change the Molina policies or drug lists quoted below. Official Molina links are not affiliate links.
The short answer
Molina can cover testosterone replacement therapy (TRT) when your exact plan covers the product and you meet that plan’s rules. The important Molina document is not a single national copay. It is a clinical coverage policy plus a state drug list, and those two papers do not always tell the same kind of story.
Policy C2270-A, “Testosterone,” has a current effective date of August 30, 2026 (original effective date April 12, 2018; last P&T approval July 29, 2026; next review due July 2027). For hypogonadism, that policy asks for documentation of congenital or acquired primary or hypogonadotropic hypogonadism, at least two morning (before 10 a.m.) total testosterone baseline levels done on separate days within the past six months that are low by the lab’s reference values, and a trial and failure of at least one generic injectable product and at least one generic topical product. Initial and continuation approvals are written as 12 months. The policy also lists “hypogonadism associated with aging” and use “to enhance athletic performance” among uses not recommended for general approval. Age for the hypogonadism pathway is 18 and older.
The three 2026 Molina Marketplace formularies we opened — California, Illinois, and Nevada, each marked current as of October 1, 2026 — list generic testosterone cypionate 100 mg/ml or 200 mg/ml and testosterone enanthate 200 mg/ml with a quantity limit of 10 mL per 25 days and a minimum age of 18. They do not print a prior-authorization flag on those injection rows. They also do not list Jatenzo, Kyzatrex, Tlando, Xyosted, AndroGel, or Testopel in the androgen section we read. The tier for the same generic injection is not the same across those states, and the tier names themselves are not equivalent: California uses a four-tier design in which that injection is Tier 1; Illinois and Nevada use designs in which preferred generics are Tier 2.
A missing PA flag on a drug list is not a promise that policy C2270-A will be ignored. A posted coverage policy is not a promise that every pharmacy claim is stopped for review. Check both documents for your contract.
If your Molina plan will not cover the product you were prescribed, or you want a cash-pay online route instead of a coverage review, start with TRT Provider Guide's Find My TRT Path tool or compare a published cash-pay program such as Male Excel first, then Hone. Those links do not make Molina cover the visit or the medication.
What does Molina policy C2270-A actually require?
C2270-A is a Drug and Biologic Coverage Criteria document. It applies to a long list of testosterone products, including injections, gels, oral testosterone undecanoate capsules (Jatenzo, Kyzatrex, Tlando, Undecatrex), Xyosted, Aveed, Testopel, and several topical brands. The Pharmacy and Therapeutics Committee language in the policy says the drug benefit is a mandatory generic benefit, and that generic drugs will be dispensed whenever available.
For hypogonadism, the required medical information is written as all of the following:
- Documentation of congenital or acquired hypogonadotropic hypogonadism (for example, gonadotropin or LHRH deficiency, or pituitary-hypothalamic injury from tumors, trauma, or radiation) or congenital or acquired primary hypogonadism (for example, testicular failure due to cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome, or orchidectomy). The policy adds a reviewer note to see the appendix for Texas Marketplace.
- At least two morning (before 10 a.m.) total testosterone baseline levels on separate days within the past six months that are low per the laboratory’s reference values, with documentation required. The policy then cites Endocrine Society and AUA language, including that several clinical trials and the AUA have used a 300 ng/dL figure.
- Documentation of a trial and failure of at least one generic injectable product and at least one generic topical product.
- A prescriber attestation, or a reviewer finding, that FDA-labeled contraindications have been addressed in the submitted documentation. The policy lists product-specific contraindications, including language that certain subcutaneous enanthate and oral testosterone undecanoate labels are not for hypogonadal conditions “not associated with structural or genetic etiologies (e.g., age-related hypogonadism).”
Continuation requires adherence (the policy uses an 85% threshold, or a documented temporary stop for surgery or infection), no intolerable toxicity, and documentation of a clinical benefit. Duration is 12 months for both initial authorization and continuation. The hypogonadism pathway has no extra prescriber-specialty requirement in this policy; the delayed-puberty pathway, which is separate, must be prescribed by or in consultation with a pediatric endocrinologist and starts at age 14.
The policy recommends that oral and topical products be billed under the pharmacy benefit, and that intramuscular injections and Testopel may be pharmacy or medical benefit, administered in a non-hospital facility-based location. That split matters if your clinic wants to place a pellet or give an office injection.
C2270-A also points transgender-health requests to a separate Molina Gender Dysphoria Hormone Therapy policy. This page is about testosterone replacement for diagnosed hypogonadism, not that separate policy.
Do Molina Marketplace drug lists agree with each other?
No, not on tier, and not even on what the word “tier” means.
All three lists we opened were marked current as of October 1, 2026, and all three put generic testosterone cypionate 100 mg/ml or 200 mg/ml and testosterone enanthate 200 mg/ml at a quantity limit of 10 mL per 25 days, with a minimum age of 18, and with no PA flag on those rows. After that, they diverge.
California’s legend describes Tier 1 as preferred generic drugs and low-cost brand-name drugs, the lowest enrollee cost sharing. Illinois and Nevada describe Tier 2 as preferred generic drugs; their Tier 1 or PREV label is for preventive drugs with $0 cost sharing. A “Tier 2” injection in Illinois is therefore not the same kind of number as a “Tier 2” methyltestosterone in California.
The 10 mL-per-25-day quantity limit is easy to miss if you only look for a PA box. Ask your prescriber whether the written quantity fits that limit before the pharmacy submits the claim.
Is Molina Medicaid the same as Molina Marketplace?
No. We also opened Molina Nevada Medicaid policy C21799-A, current effective date January 1, 2026 (last P&T approval October 29, 2025; next review due October 2026). That Medicaid policy still asks for a documented primary or hypogonadotropic hypogonadism diagnosis and at least two morning total testosterone baseline levels that are low per the lab’s reference values. It does not include the C2270-A requirement to trial both a generic injectable and a generic topical product, and it does not use the “before 10 a.m.” and “within the past 6 months” wording in the same way. Age for hypogonadism is still 18 and older.
If your card is Molina Medicaid in another state, or Molina Medicare, do not treat the Nevada Medicaid policy or a Marketplace formulary as your rulebook.
How much will TRT cost with Molina?
There is no honest national Molina copay. The three Marketplace lists already disagree on the injection tier, and methyltestosterone jumps from California Tier 2 to Nevada Tier 4 to Illinois specialty Tier 5. Your deductible, copay or coinsurance, quantity limit, and whether the claim runs through pharmacy or the medical benefit all change the total. The lists point members to MolinaHealthcare.com for an electronic formulary and to the plan’s Benefits at a Glance materials for cost-sharing amounts.
Ask Molina for a plan-specific estimate for the exact product and pharmacy, then add visits and labs. For cash-pay ranges, see TRT cost.
Can you use Molina with an online TRT clinic?
Sometimes a clinic can bill a plan for a telehealth visit. That is not the same as Molina covering the medication, the labs, or a compounded product. Many online TRT programs are cash-pay and do not submit a Molina pharmacy claim.
If you want a provider that bills insurance, start with TRT providers that take insurance and confirm your exact Molina network. If you want a defined cash-pay online program instead, Male Excel is first and Hone is second. Compare published prices on our Male Excel cost page. Use Find My TRT Path if the path is unclear.
See Male Excel’s published cash-pay program
How do I check my own Molina testosterone coverage?
- Decide whether your card is Marketplace, Medicaid, Medicare, or another Molina product, and in which state.
- Open that plan’s current drug list and, if one applies, the current testosterone coverage policy. The California, Illinois, and Nevada Marketplace files we used were current as of October 1, 2026; C2270-A is effective August 30, 2026.
- Search the exact product, strength, and form.
- Write down the tier, PA flag if any, quantity limit, and age limit. Then read the matching clinical policy, even if the list has no PA flag.
- Ask your prescriber how they will document the diagnosis, the two morning results, and — if C2270-A applies — the generic injectable and generic topical trials.
- Request a cost estimate and add visit and lab bills.
If Molina denies the request, read the reason code and use the appeal steps in testosterone prior authorization. A cash-pay option can run in parallel; it does not replace an appeal.
What should you settle with your doctor first?
Coverage rules are not a diagnosis. FDA-approved testosterone products carry product-specific safety warnings, including blood-pressure and other risks that depend on the exact label. Testosterone can lower sperm production, and that effect may not fully reverse. C2270-A also discusses FDA’s 2025 labeling work after the TRAVERSE trial and ambulatory blood-pressure studies, including retained “limitation of use” language for age-related hypogonadism and added blood-pressure warning language. Check the current product label, not only a coverage policy.
This page does not tell you to start, stop, or change testosterone, and it does not interpret your labs. See FDA-approved testosterone products, TRT and blood pressure, and TRT and fertility.
How we built this page
We opened Molina policy C2270-A (effective August 30, 2026); the 2026 California, Illinois, and Nevada Marketplace formularies marked current as of October 1, 2026; and Nevada Medicaid policy C21799-A (effective January 1, 2026). The C2270-A file we retrieved carried an HTTP last-modified date of November 6, 2026. We compared those primary documents so this URL would add Molina-specific policy and state-list evidence that the site’s generic insurance pages do not already serve.
What we could not confirm from the public materials used here: whether every Molina Marketplace state uses one of these two tier schemes; whether a later formulary update after October 1, 2026 changed a row; how often a claim for a no-PA-flag injection is still reviewed under C2270-A; and Medicaid or Medicare criteria outside the Nevada Medicaid policy we opened.
What we did not do: examine anyone, read anyone’s labs, submit a Molina claim, or enroll with a provider. A clinician has not reviewed this page.
Molina and TRT: frequently asked questions
Does Molina cover TRT?
It can, when your plan covers the product and the applicable policy criteria are met. Marketplace drug lists and the August 30, 2026 coverage policy answer different parts of that question.
Does Molina cover testosterone injections?
The California, Illinois, and Nevada Marketplace lists we opened include generic testosterone cypionate and enanthate, with a 10 mL-per-25-day quantity limit and a minimum age of 18, and with no PA flag on those rows. The tier is 1 in California and 2 in Illinois and Nevada. Policy C2270-A still sets diagnosis, lab, and trial-and-failure criteria for the products it lists.
Why does Molina ask for a generic gel trial if I want an injection?
That combination trial — at least one generic injectable and at least one generic topical — is written into C2270-A’s hypogonadism section. The Nevada Medicaid policy we opened does not include that same step. Ask which policy applies to your card before you assume either rule.
Does Molina cover Kyzatrex, Jatenzo, or Xyosted?
Those brands are named in C2270-A’s “products affected” list. They did not appear in the androgen section of the three Marketplace formularies we opened. A policy mention is not the same as a formulary row.
Will Male Excel or Hone bill Molina for me?
Do not expect a cash-pay online program to submit your Molina pharmacy claim, and do not expect compounded medication to appear as an FDA-approved formulary product on these lists.
Sources
- Molina Healthcare. Testosterone, policy C2270-A, current effective date August 30, 2026; last P&T approval/version July 29, 2026; next review due July 2027. PDF
- Molina Healthcare of California. 2026 Marketplace Formulary (List of Covered Drugs), current as of October 1, 2026. PDF
- Molina Healthcare of Illinois, Inc. 2026 Marketplace Formulary (List of Covered Drugs), current as of October 1, 2026. PDF
- Molina Healthcare of Nevada, Inc. 2026 Marketplace Formulary (List of Covered Drugs), current as of October 1, 2026. PDF
- Molina Healthcare. Testosterone, Nevada Medicaid policy C21799-A, current effective date January 1, 2026; last P&T approval October 29, 2025; next review due October 2026. PDF
- Molina Healthcare. Member / electronic formulary landing, as cited in the Marketplace lists. MolinaHealthcare.com