Provide cms medicare parts c and d general compliance april 2020 and medicare fraud abuse. Prime has been a leader on controlled substances misuse for more than a decade.
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Prime therapeutics tier list. Every pharmacy in primes network must do the following to meet compliance requirements. Not all generic drugs are equivalent to the available brand drug. A drug list formulary is a list of generic and brand name drugs covered by a health plan. Our program combines existing and new services to help address this national epidemic. Health insurance marketplace 6 tier drug list august 2020 plan year 2019. Formulary exception formthis document will contain the diagnosis and an explanation for why the prescription is suggested above those which are potentially more commonly used.
If you wish to request coverage for a patients prescription which hasnt been listed on their health insurance providers formulary you will need to fill out a prime therapeutics prior authorization form aka. If your employer offers health plan coverage and your prescription drug benefits are administered by prime therapeutics youll find information about prescription drugs when youre signed in. Coverage of prescription drugs and supplies listed on the drug listformulary is subject to your benefit plans design and coverage provisions and may differ from that listed. Xii abbreviation key. The drug list is developed by a pharmacy and therapeutics pt committee. Prevent detect and report february 2020 training to each pharmacist and pharmacy staff member upon hire and annually thereaftercms training is available on the cms website through their mln.
Prime specialty pharmacy a wholly owned subsidiary of prime therapeutics is a leading edge mail order pharmacy built on the strength of smart clinical solutions solid benefit design cost controls and an unwavering commitment to the health and wellbeing of its members.
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