Credentialing

Important information

Updated Insurance Coverage Information

To submit a renewal, submit your updated certificate of insurance to primecredentialing@primetherapeutics.com. See the Renewal Checklist below.

Express Scripts Networks

To apply for Express Scripts networks, go to www.ESIProvider.com and follow the steps below to create a new account and apply:

1. Select create “New Account” or log into your existing account
2. Once logged in, select Begin New Process
3. Under Begin New Process, select “Apply to be a network provider”
4. Complete the application and submit all required documentation
5. Wait for next steps and confirmation from Express Scripts’ Credentialing team

If you have any questions, please email us at PrimeCredSupport@Express-Scripts.com.

Chain, PSAOs or Participating Providers

To submit a new Chain or PSAO application OR if you’re currently participating in Prime and Magellan Rx networks and would like to join additional networks, please email ProviderRelations@primetherapeutics.com

PSAO-Affiliated Pharmacies

If you want to join Prime and Magellan Rx Networks through your PSAO or change PSAOs, please contact your PSAO and have them submit your pharmacy’s information to Prime and Magellan Rx directly.

Specialty Pharmacies

To join Prime and Magellan Rx Specialty Networks, please contact our Specialty Credentialing team at specialtycredentialing@primetherapeutics.com.

Credentialing and Re-Credentialing Checklists

Please have the following documentation ready to attach:

Accepted file types: pdf, csv, txt, png, jpg, xls and xlsx.

• Copy of State Pharmacy License(s) and Pharmacy Licenses for all states that the pharmacy delivers or mails to
• Copy of Pharmacist-in-Charge license and all Pharmacists licenses
• Copy of DEA certificate (must have schedules 2, 2N, 3, 3N, 4, 5)
• Copy of Certificate for General Liability and Professional Liability insurance ($1 million each occurrence and #3 million aggregate are required for both General and Professional) Certificate MUST clearly state General Liability and Professional Liability
• List of all LTC facilities including city/state (if applicable)
• Add additional information required to respond to questions in this exhibit

Renewals Checklist

Please have the following documentation ready to attach:

Accepted file types: pdf, csv, txt, png, jpg, xls and xlsx.

• Copy of Certificate for General Liability and Professional Liability insurance ($1 million each occurrence and #3 million aggregate are required for both General and Professional) Certificate MUST clearly state General Liability and Professional Liability
• New Insurance Expiration Date and Coverage Amounts

Effective Date: September 9, 2020

Prime and Magellan Rx require that, unless otherwise credentialed by Prime and Magellan Rx, pharmacies participating in retail networks managed by Prime and Magellan Rx 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 and Magellan Rx in its sole discretion at any time.

During Credentialing, Prime and Magellan Rx reviews a pharmacy’s location to determine if they are located in either a federally defined or Prime defined “heat” zone.