You’re the link between our members and their medicine.
They count on you for the information they need
about their prescriptions.
You can count on us to help you find the information you need:
- A dedicated 24-hour pharmacy contact center
- Ongoing communications about plan changes and additions
- Regular news and updates on current pharmacy topics
Each Pharmacy or Pharmacy Services Administration Organization (PSAO) participating in Prime’s Specialty Pharmacy Networks must adhere to requirements for reporting as outlined in Prime’s contractual reporting requirements, including but not limited to clinical reporting, performance guarantees and manufacture assistance reporting.
If your pharmacy needs access to the reporting requirements or you have questions about contractual reporting requirements - please contact the Specialty Network Contracting team at: firstname.lastname@example.org
Pharmacy claim processing
Compliance/Fraud, waste and abuse
Every pharmacy in Prime’s network must do the following to meet compliance requirements:
Training: Provide CMS' "Medicare Parts C and D General Compliance (April 2020)" and "Medicare Fraud & Abuse: Prevent, Detect, and Report (February 2020)" training to each pharmacist and pharmacy staff member upon hire and annually thereafter. CMS training is available on the CMS website through their MLN Learning Management System (LMS).
Certification: Complete the FWA Certification form that is part of your pharmacy profile on NCPDP. Download instructions
Record keeping: Maintain internal training logs.
Policies and procedures: Maintain internal training protocols.
Report compliance, privacy, or fraud, waste and abuse concerns
If you suspect fraud, waste or abuse (FWA) by a covered person, prescribing provider, participating pharmacy or anyone else, notify Prime at 800.731.3269 or email@example.com.
For suspected FWA involving the Federal Employee Plan, please notify: