MHCP Fee-for-Service Pharmacy

Article 1: MHCP Fee-for-Service Pharmacy – Overview
Purpose: Help staff explain what the MHCP Fee-for-Service pharmacy program is and what Prime Therapeutics does.
Tags: MHCP, Pharmacy, Prime Therapeutics, Fee-for-Service, Magellan, Prior Authorization

Q: What does “Fee-for-Service” mean for my Medical Assistance pharmacy coverage?
A: Fee-for-Service (FFS) means your pharmacy benefits are managed directly by the State (DHS), not by a managed care health plan. The State contracts with Prime Therapeutics to handle payments, prior authorizations, and questions about your prescriptions.

Q: Who is Prime Therapeutics?
A: Prime Therapeutics (formerly Magellan Health) manages pharmacy services for MHCP Fee-for-Service members. They process payments for prescriptions, review prior authorization requests, and run a 24/7 call center.

Q: What kinds of medications does this program cover?
A: It covers outpatient prescriptions you pick up at a pharmacy and certain drugs given by a doctor or nurse in a clinic or hospital (for example, shots or infusions).

Internal Notes:

• Applies only to people on MA Fee-for-Service. Managed care members must contact their plan’s pharmacy number.
• Hub staff do not contact Prime directly on behalf of callers—provide the number instead.

Article 2: Pharmacy Card and ID Information
Purpose: Help staff answer pharmacy card questions and direct callers who need replacements.
Tags: MHCP, ID Card, Pharmacy, Prime Therapeutics, Fee-for-Service

Q: What do I give my pharmacy so they can fill my prescription?
A: Share your MHCP pharmacy ID information:

• RxBIN: 026787
• RxPCN: 5309662024
• RxGroup: MNMEDICAID

Q: What if I lost my MHCP card?
A: You’ll need to contact your county eligibility worker to request a replacement card.
Prime Therapeutics and DHS can’t send replacement cards.

Q: Can I still get my medicine if I don’t have my card?
A: Yes—most pharmacies can look up your coverage using your MHCP number or Social Security number, but having the card is best.

Internal Notes:

• If caller doesn’t know how to reach their county worker, help locate contact info in the County and Tribal Human Services Directory.
• Reassure callers that losing the card doesn’t stop their coverage.

Article 3: Medication Coverage and Prior Authorization
Purpose: Help staff explain how callers can find out if their medication is covered and what “prior authorization” means.
Tags: MHCP, Drug Coverage, Prior Authorization, Pharmacy, FFS

Q: How do I know if my medicine is covered by Medical Assistance?
A: Use the Drug Lookup Tool on the DHS website. It shows:

• Whether the drug is covered
• If it’s on the Preferred Drug List (PDL)
• Whether it needs prior authorization (extra approval before it can be filled)

Q: What does “prior authorization” mean?
A: Some medicines need DHS approval before the pharmacy can fill them. Your doctor usually sends this request to Prime Therapeutics.

Q: What if my pharmacy says my medicine isn’t covered?
A: Ask the pharmacy to check the Drug Lookup Tool or call Prime Therapeutics for help (1-844-575-7887).

Internal Notes:

• The tool is for FFS coverage only. Managed care plans have separate lists.
• Staff can guide callers to where the tool is located but should not interpret coverage results.

Article 4: Getting Help from Prime Therapeutics
Purpose: Help staff know when to refer callers to Prime Therapeutics and what issues they handle.
Tags: MHCP, Prime Therapeutics, Pharmacy, Help, Claims, Prior Authorization

Q: Who do I call if the pharmacy won’t fill my prescription?
A: Call Prime Therapeutics Pharmacy Call Center at 1-844-575-7887. They’re open 24/7, every day of the year.

Q: What can Prime Therapeutics help me with?
A:

• Pharmacy coverage questions
• Claims or billing issues
• Checking prior authorization status
• Help if a pharmacy refuses to fill a prescription

Q: Can I call them about my other Medical Assistance services?
A: No, Prime Therapeutics only handles pharmacy-related questions for Fee-for-Service MA members.

Internal Notes:

• Staff can provide the number and explain what to ask.
• For non-pharmacy services (dental, transportation, etc.), refer to DHS Health Care Consumer Support.

Article 5: Getting Help from DHS (Non-Pharmacy Questions)
Purpose: Help staff route non-pharmacy FFS questions to the correct DHS line.
Tags: MHCP, FFS, DHS, HCCS, Contact, Non-Pharmacy

Q: Who do I call if my question isn’t about prescriptions?
A: Contact DHS Health Care Consumer Support (HCCS) at 1-800-657-3672.

Q: What can HCCS help with?
A: They handle non-pharmacy Fee-for-Service benefits and services (for example, coverage for doctor visits, equipment, or transportation).

Q: When are they open?
A: Monday through Friday, 8:00 AM to 4:00 PM.

Internal Notes:

• HCCS does not handle pharmacy claims, refills, or prior authorizations.
• Always verify that the caller’s question is not pharmacy-related before referring.