Impacted: Health plan clients 

What you need to know

A winter storm is set to impact the South, Midwest and Northeast parts of the United States from Friday, Jan. 23 – Monday, Jan. 26, which may impact members who reside in these areas. Provided are a few reminders about Prime Therapeutics’ (Prime) standard actions in the event of major weather events or other developments that could pose significant barriers to medication access.

Prime is actively monitoring call volumes and will make necessary adjustments as needed. Operational teams, including our contact center, are closely observing the situation in the event we need to implement appropriate measures to ensure consistent service delivery. 

Ensuring access for members 

Prime has processes in place to aid members who are affected by adverse events and unexpected pharmacy closures that affect their access to medications. During any potential adverse event, Prime will: 

• Rapidly assess client impact using zip code data to determine the affected service area(s) – this is monitored continuously (24/7).  
• For RxCLAIM clients:Execute a Dynamic Prior Authorization (DPA) early-refill override for all members in a state governor-declared disaster area, using a standard two-week default period for the DPA. This includes notifying pharmacies within the impacted service area of the DPA put into place.
• For Judi® clients: Implement the SCC13 code override at the state level for members and pharmacies located in state governor declared disaster areas. 
• Notify clients of the initiated DPA and SCC13 activity. Clients can shorten or extend the DPA period by communicating with their health plan markets representative.  
• Provide DPA reporting back to clients. 
• Actively monitor impacted employees to continue to meet service levels.  

During active weather events, the Healthcare Ready: RxOpen site may be activated by the National Council for Prescription Drug Programs (NCPDP) to identify pharmacy chains and local pharmacies that are closed due to adverse events.  

Meeting home delivery and specialty pharmacy needs 

Regardless of which home delivery and specialty providers your plan works with, Prime and our vendors have the following safeguards in place: 

• Continuous monitoring of adverse weather events to determine possible impacts to members and shipments.  
• Contingency plans in place to provide 24/7 coverage for urgent member needs, including pharmacist consultations, necessary shipments to alternate locations and retail fills when and where possible.  
• Monitoring of shipments and proactive management of packages where deliveries are expected to be impacted by the event. 

Prime is in regular contact with our home delivery and specialty pharmacy vendors and will provide updates as needed during this event.  

Questions 

Reach out to your Prime account team representative if you have questions about Prime’s adverse event preparedness and unexpected pharmacy closures.