Preferred Drug List

Please familiarize yourself with the Preferred Drug List as you prescribe medications for Passport Health Plan by Molina Healthcare beneficiaries. Thank you for your cooperation.

Passport Health Plan by Molina Healthcare Preferred Drug List (PDL)

  

Passport Health Plan by Molina Healthcare Retail Pharmacy Network

 

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

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..

 

 

 

 

icon Adobe Acrobat Reader is required to view the file(s) above. Download a free version.