Drug Authorizations

Revised: August 15, 2025

Minnesota Health Care Programs (MHCP) currently contracts with Prime Therapeutics (formerly known as Magellan Health) to process authorization requests for covered outpatient prescription and physician-administered drugs that require authorization.

· Pharmacies and prescribing providers must submit all drug authorization requests to Prime Therapeutics, the MHCP prescription drug prior authorization (PA) agent, by phone at 844-575-7887, or by fax at 866-390-2778, or through electronic PA.

· Refer to the MHCP Provider Manual posted under Resources - Forms and Documents on the Minnesota Medical Assistance Portal for additional information.

· Prior authorization requests must be submitted using the Medical Prior Authorization Form or Prescription Drug Prior Authorization Form available under Resources - Forms and Documents on the Minnesota Medical Assistance Portal.

· MHCP prescription drug prior authorization agent call center hours are seven days a week, 24 hours a day and 365 days a year.

· Pharmacists may dispense up to a 72-hour supply of a covered prescribed medication requiring authorization in emergency. situations. Refer to the Emergency Protocols chapter in the MHCP Provider Manual posted under Resources - Forms and Documents on the Minnesota Medical Assistance Portal for additional information.

Authorization with third-party liability

MHCP will pay for the copay or coinsurance amount, up to the MHCP allowed amount, if the authorization request is approved.

The claims system will bypass the prior authorization requirement when the member has third party insurance that has paid 60 percent, or more, of the MHCP allowed amount of the claim. Refer to the Coordination of Benefits (COB) chapter in the MHCP Provider Manual posted under Resources - Forms and Documents on the Minnesota Medical Assistance Portal for additional information.

Providers do not need to submit a prior authorization request for office administered drugs if the primary payer is Medicare. MHCP will pay for the coinsurance amount, up to the MHCP allowed amount, without authorization.

You should continue to submit authorization requests for medical supplies, including diabetic supplies, to the medical review agent. Direct only drug prior authorization requests to Prime Therapeutics.

Additional Resources

MHCP Pharmacy Quick Reference webpage
Minnesota Statutes, 256B.0625, subdivision 25b. (Authorization with third-party liability)
Minnesota Medical Assistance Portal (hosted by Prime Therapeutics)