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)


Passport by Molina Healthcare Retail Pharmacy Network


Medical Drugs

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:

Pharmacy Providers should use the following BIN/PCN/Group when billing MedImpact:

  • BIN = 023880
    GRP = KYM01

Technical Call Center: (800) 210-7628



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