Preferred Drug List
Please familiarize yourself with the Preferred Drug List as you prescribe medications for Passport by Molina Healthcare beneficiaries. Thank you for your cooperation.
Passport by Molina Healthcare Preferred Drug List (PDL)
- Preferred Drug List
- Passport OTC Drug List
- Pharmacy and Therapeutic Meetings
- Aduhelm Clinical Criteria
Passport by Molina Healthcare Retail Pharmacy Network
Physician administered drugs (PAD) are covered through Passport. Providers should fax PAD requests to (844) 802-1406.
PAD related inquires can be directed to Passport at (800) 578-0775.
Prescription Claims Processing
Retail pharmacy drugs should be billed to MedImpact. For retail pharmacy drug prior authorization requests, please fax your requests to the fax number below.
Pharmacy related inquires can be directed to MedImpact at the number below:
- Phone: (800) 210-7628
- Prior Authorization Call Center: (844) 336-2676
- Drug PA Fax: (858) 357-2612
Pharmacy Providers should use the following BIN/PCN/Group when billing MedImpact:
- BIN = 023880
PCN = KYPROD1
GRP = KYM01
Technical Call Center: (800) 210-7628
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