Pharmacy Provider Resources

Pharmacy Provider Resources
Pharmacy Provider Resources

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Prime Therapeutics Specialty Network(s) is for medications used to treat complex or rare conditions such as multiple sclerosis, rheumatoid arthritis, hepatitis C or hemophilia.  Covered persons can obtain these types of medications from participating pharmacy providers.  You can request access to these lists based on pharmacy's participation.


Specialty Base Rate List for Specialty Prescription Drug Services provided in accordance to Prime's Pharmacy Match Network. You can request access to this list based on pharmacy's participation in the network.


Pharmacy Match Illinois Base Rate List for Prescription Drug Services provided in accordance to Prime’s Pharmacy Match Illinois Network. You can request access to this list based on pharmacy’s participation in the network.


The Maximum Fair Price (MFP) Fee Schedule contains information for each MFP eligible drug and the dispensing fee applicable to each eligible prescription claim. You can request access to this list based on pharmacy’s participation in the network.


The IntegratedRx Drug lists for Specialty Prescription Drug Services provided in accordance to Prime’s IntegratedRx Networks. You can request access to this list based on pharmacy’s participation in the network.


The ERA or 835 is an electronic file which provides claim payment information in the HIPAA compliant 835 ASC X12N/005010X221A1 version.


EFT is a secure method of payment by which funds are electronically transferred directly into a specified bank account.


List of drugs used to determine if a pharmacy is in compliance with Prime’s Credentialing Threshold.