Pharmacy credentialing
Use the link below to:
- Responding to a solicitation for a Credentialing application
- Complete a Re-Credentialing application
- Submit updated insurance coverage information
Effective Date: September 9, 2020
Prime requires that, unless otherwise credentialed by Prime, pharmacies participating in retail networks managed by Prime comply with the following specialty, compounding, and single ingredient dispensing thresholds:
1) Specialty threshold: Pharmacy will not be greater than 70% specialty dispensing rate
2) Compounding threshold: Pharmacy will not be greater than 10% compound dispensing rate
3) Mail order threshold: Pharmacy will not be greater than 10% mail order dispensing rate
4) Single ingredient threshold: Pharmacy will not be greater than 10% single ingredient dispensing rate based on the drug list located here under the Pharmacy Provider Tools.
Specialty, compounding, mail order and single ingredient thresholds may be changed by Prime in its sole discretion at any time.
During Credentialing, Prime reviews a pharmacy’s location to determine if they are located in either a federally defined or Prime defined “heat”zone.