Visit our pharmacy website for:
- Forms
- Quantity limits
- Member programs
- Coverage exceptions
- Specialty medications
- Medication lists/formularies
- Medication policies and pre-authorization requirements
Submit pre-authorization requests with CoverMyMeds.
Our toolkit includes guidelines, tools and resources to help support you as you care for patients needing pain management or who are struggling with opioid addiction.
Join the Prime Therapeutics IntegratedRx - Medical Network
Prime Therapeutics is currently credentialing and contracting providers for this network. You can reach out to your Prime contact to complete the process. If you do not have a Prime contact established, please email Prime Provider relations.
To start IntegratedRx - Medical Network credentialing, you can also visit Prime's credentialing website.
- Each provider group or facility that administers specialty medications needs to be credentialed and contracted as a dispensing provider with Prime Therapeutics.
- If your organization operates a specialty pharmacy that you want included in this network, your specialty pharmacy will need to complete the credentialing process to be included, even if they have an existing pharmacy contract with Prime Therapeutics.
- Your contract with Prime will have a reimbursement schedule that includes the medications in the BridgeSpan EquaPathRx program.
Using real-time benefit check can improve the patient experience, decreasing their financial strain and improving medication adherence. It can also lead to better provider and patient conversations about treatment plans and reduce your time spent on administrative tasks.
To create easier access to a preferred medication database for our members, we’ve partnered with Arrive Health to integrate a real-time benefit check tool for prescribed medications that works within your electronic medical record (EMR) system.
Arrive Health works with many of the larger, national EMR systems (e.g., Epic and Cerner) to provide you quick access to pharmacy benefit checks. With 99% transaction accuracy and over 10 million transactions per month, Arrive Health is a trusted partner to help patients get the right medication at the right price.
How it works
Real-time benefit check information will display when the following criteria are met:
- Patient eligibility has been pulled (workflow varies by EMR system)
- Patient’s pharmacy benefits are covered by a participating pharmacy benefits manager (PBM) (e.g., Prime Therapeutics)
- You’ve entered the national drug code (NDC), preferred pharmacy NPI, quantity and days supply
The tool will present the following patient-specific coverage information:
- Coverage status (covered, not covered, covered with restrictions)
- Coverage alerts (pre-authorization required, quantity limit issue, refill too soon, step therapy, etc.)
- Out-of-pocket costs for the patient
- Formulary-driven medication alternatives
- Pharmacy options
Note: This tool is only for medications filled at pharmacies, not those dispensed or administered in the provider office.
Available now
The real-time benefit check tool is available for all members now. Contact your EMR vendor to find out how to connect your system to the Arrive Health solution.
Learn more about Arrive Health for providers.
Services provided | To be reimbursed directly for medications provided during a visit/stay |
---|---|
Ambulatory surgery center (ASC) | Include in medical claim |
Emergency room | Include in medical claim |
Home health | Include in medical claim |
Hospital or other inpatient setting | Include in medical claim |
Medical or dental provider/clinic | Include in medical claim if covered under medical benefits Submit claim to TransactRx if covered under Rx benefits |
Pharmacy | Pharmacy submits claim through PBM |
Skilled nursing facility (SNF) | Include in medical claim |
Urgent care | Include in medical claim |
Vaccines |
|
Infusion medications |
|