As communicated on Aug. 6, 2025, Prime Therapeutics (Prime) has initiated an enterprise project to comply with requirements regarding National Council for Prescription Drug Programs (NCPDP) retail pharmacy standards and Medicaid pharmacy subrogation standards outlined in a Centers for Medicare & Medicaid Finale Rule (CMS-0056-F).   

Provided is an update on the status of Prime’s NCPDP telecoms/claims F6 project and a timeline of key accomplishments.  

Client action will be required to uplift your internal systems to accommodate the mandated updates to claim data and participate in joint testing as we enter the testing phase in Q4 2026.  

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Timeline 

In 2025, Prime has worked diligently to evaluate the requirements and establish a plan to execute these changes. Prime is taking a proactive approach to ensure we meet CMS requirements well ahead of the compliance deadline, minimizing risk and supporting uninterrupted service for all stakeholders. 

Key milestones

• Q1 2026: Completion of requirements for adjudication platforms
• Q2 2026: Program and project planning complete
• Q4 2026: Development complete for core and ancillary applications  
• Q4 2026 – Q3 2027: Internal and joint testing completed
• Q3 2027: Transition activities begin
• April 14, 2028: Regulatory compliance achieved

How Prime will partner with our clients 

Action will be needed from Prime and clients to comply with the requirements, and we are committed to being an active partner throughout. Prime will routinely engage our clients to support them through this transition by: 

• Assessing current systems and processes: Prime will work with clients to review existing file formats, workflows and dependencies to identify areas impacted by the upcoming changes.
• Planning client testing: Prime will schedule time for collaborative testing phases with clients between October 2026 and August 2027 to validate compliance and ensure smooth integration.

Prime recommends that clients begin planning to ensure the necessary resources are available to support file changes, process updates and testing activities related to the transition. 

For clients migrating to Judi, Prime is working to align NCPDP F6 compliance activity with the Judi migration schedule to reduce overlapping efforts and streamline resource management.  

Next steps 

Prime will continue to provide updates that include detailed information and revised timelines, enabling all parties to effectively allocate resources and prepare for testing and data exchanges. We will provide these updates on a quarterly basis, with supplemental communication as necessary.

Questions

Please reach out to your Prime account team representative.