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Two unique credentials set Prime apart

March 14, 2017


Prime Therapeutics (Prime) holds the usual alphabet soup of accreditations and certifications: URAC, ACHC, NABP-VIPPS. Now Prime also holds two new certifications that will make a big difference to our clients. 

The National Committee for Quality Assurance (NCQA) has certified Prime in two new areas: 

  1. NCQA Utilization Management (UM) and
  2. NCQA Health Information Products (HIP) – HIP Certification in Pharmacy Benefit Information

These aren’t just logos on our website. Prime’s certifications and accreditations mean that we go above and beyond to help our members get the medicine they need to feel better and live well. We have operational practices in place that drive quality processes, superior member experiences and overall compliance. 

Prime has:

  • Outstanding member service
  • Dedication to continuous quality improvement
  • Evidence-based operations

This takes a special commitment. These certifications represent: 

  • Our ongoing commitment to quality
  • Our robust compliance and accreditation programs
  • The contributions of hundreds of subject matter experts
  • The active participation of our employees in making excellence a part of our culture

Here’s a brief description of these two new certifications:

  • The NCQA HIP Certification in Pharmacy Benefit Information means clients can delegate complex prescription drug programs to Prime and have confidence in our service excellence to members. 

The HIP Certification in Pharmacy Benefit Information demonstrates Prime’s expertise in gathering and disseminating health care information for health plan members. Because Prime now has this certification, our NCQA-accredited clients may receive automatic credit from NCQA for their own MEM4 standards. This means NCQA requires less documentation from clients in their reviews, less oversight by Prime’s clients, and less documentation from Prime to its clients to confirm we are meeting NCQA’s standards. See more.

  • NCQA UM: Prime received certification in Utilization Management (UM). This program shows that Prime’s systems, processes and the personnel who conduct UM reviews follow NCQA’s quality standards. It validates that Prime is providing quality UM services to our clients and their members. See more.

The NCQA seal is a widely recognized symbol of quality. Those earning accreditation or certification must pass a rigorous, comprehensive review and must annually report on their performance. 

Many employers – particularly the Fortune 500 – only do business with NCQA-accredited plans to maximize the value of their health care spending. The National Business Group on Health’s widely used eValue8™ tool captures NCQA Accreditation status and HEDIS/CAHPs scores as an important indicator of a plan’s ability to improve health and health care.

“These certifications showcase Prime’s commitment to clear communication to members and to help safeguard members so they can get the medicine they need to feel better and live well,” said Ann Tobin, chief compliance officer at Prime. “It also means our clients – plan sponsors – can delegate complex prescription drug programs to Prime and have confidence in our service excellence to members.”

It’s what we do every day

Accreditations and certifications are just one more way Prime shows its commitment to quality and compliance. They make it easier for clients to do business with us. They represent standards and values important to you.

Quality and compliance are part of everyone’s job here at Prime, every day. And we stake our jobs on it. Our employee incentive plan is funded based on our performance in:

  • CMS Star Ratings
  • Drug trend and net ingredient cost
  • Achieving excellent scores in member experience performance measures

Prime’s accreditations, quality programs and compliance programs give us a solid foundation for providing excellent, evidence-based services for our clients and members while lowering cost of care and improving health outcomes. 

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