Forms and Documents


MHCP_Provider_Manual
MN_Medicaid_Oncology_Drug_List
Payer Specifications
IHS Pharmacy Prescription Drug Prior Authorization Request Form
Medical Drug Prior Authorization Form
Prescription Drug Prior Authorization Request Form 12.16.24
Prescription Drug Reconsideration Request Form
Synagis Prior Authorization Request Form
Value-Based Supplemental Rebate Agreement
30 Day Pharmacy Provider Notice
60 Day Pharmacy Provider Notice
MNRx_announcement_20240708
MN Pharmacy Modernization Stakeholder Meeting_8_21_2024
MNRx_modernization_meeting_materials_20231130
MNRx_modernization_meeting_materials_20240320
MNRx_modernization_meeting_materials_20240618
Notice of Postponement
October MHCP Pharmacy Module Modernization Project Stakeholder Meeting
MHCP_Provider_Manual
MN_Medicaid_Oncology_Drug_List
Payer Specifications
IHS Pharmacy Prescription Drug Prior Authorization Request Form
Medical Drug Prior Authorization Form
Prescription Drug Prior Authorization Request Form 12.16.24
Prescription Drug Reconsideration Request Form
Synagis Prior Authorization Request Form
Value-Based Supplemental Rebate Agreement
30 Day Pharmacy Provider Notice
60 Day Pharmacy Provider Notice
MNRx_announcement_20240708
MN Pharmacy Modernization Stakeholder Meeting_8_21_2024
MNRx_modernization_meeting_materials_20231130
MNRx_modernization_meeting_materials_20240320
MNRx_modernization_meeting_materials_20240618
Notice of Postponement
October MHCP Pharmacy Module Modernization Project Stakeholder Meeting
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