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
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’ general compliance and fraud, waste and abuse training to each pharmacist and pharmacy staff member upon hire and annually from then on.
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.
The resources needed to meet these requirements are:
Pharmacy audit and special
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: