Visit our pharmacy website for:
- Forms
- Quantity limits
- Member programs
- Coverage exceptions
- Specialty medications
- Medication lists/formularies
- Peer-to-Peer Review Request form
Submit pre-authorization requests with CoverMyMeds.
See our medication policies and pre-authorization requirements
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.
Prime Therapeutics (Prime) is our pharmacy benefits manager (PBM) for our group, Individual and Medicare members. Prime administers our pharmacy benefits, provides customer service and manages an extensive retail network.
Prime has web-based tools to help you submit pharmacy pre-authorization requests and submit claims for medications administered in your office.
Medicare Prescription Payment Plan
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 |
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