Partnership HealthPlan of California's Medical Drug List (MDL) Navigator™, a medical drug list search tool for medical providers.
What it is:
An online search tool which allows medical providers to look up drugs administered in a medical setting by drug name, NDC, HCPCS code, or HCPCS description! The MDL Navigator™ will inform users of a drug code's coverage requirements for Partnership reimbursement, including limits, restrictions, and PA criteria.
Partnership MDL Navigator™
Click here to view the instructions and tips for using Partnership MDL Navigator™ search tool.
Announcement regarding Partnership HealthPlan of California Pharmacy
Benefits and Services:
As of January 1, 2022, Partnership’s pharmacy benefit and services are carved
out to Medi-Cal Fee-For Service (FFS) and Partnership is no longer be responsible for
administering the pharmacy benefit. The pharmacy carve-out is called
Medi-Cal Rx. Medi-Cal and the Department of Health Care Services have
contracted with Magellan Medicaid Administration, Inc. (MMA) to administer the pharmacy
benefits and services including pharmacy claim processing, prior authorization
review, and operating member and provider call centers.
What this means to providers and members:
The Partnership Medi-Cal Pharmacy Formulary is no longer available nor applicable to pharmacy claims as of January 1, 2022. Pharmacies will submit Medi-Cal Rx prescription claims and TARs to Magellan Medicaid Administration, Inc. (MMA).
To see the Medi-Cal Rx Pharmacy Formulary, members and providers need to go to the State's covered drug list:
Additional Medi-Cal Rx Pharmacy Benefit Information and Resources:
Drugs Billed Directly to Partnership Through the Medical Benefit:
Partnership's Pharmacy Department continues to be responsible for overseeing the medical drug benefit (drugs administered directly to members by a medical provider and billed to Partnership as a medical claim), also known as Physician Administered Drugs (PAD). Together with State Medi-Cal advisories, direction from the Pharmacy & Therapeutics (P&T) Committee and the Physician Advisory Committee (PAC), the Pharmacy Department at Partnership establishes coverage & TAR requirements for the PAD benefit.
Note that only medical providers (hospitals, surgery center, prescriber offices and clinics) can submit claims or TARs for drugs administered to members. Pharmacies (including infusion pharmacies) must submit drug claims to Medi-Cal Rx (Magellan Medicaid Administration, Inc.).