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Coverage and cost

  • What does it mean if my prescription requires a Prior Authorization or Step Therapy?

    When a Prior Authorization is needed, it means your prescription drug plan must approve your prescription before PrimeMail can fill your order. Step Therapy means you take a "step" approach with your medicines. You may first need to try a more clinically appropriate or cost effective drug before other drugs are approved by your prescription drug plan. Certain prescription medicines must be tried without success before other medicines will be approved. PrimeMail will work with your doctor to validate what drugs have been tried.

    For both Prior Authorizations and Step Therapy, PrimeMail will work closely with your doctor to determine if your claim will be authorized. This process may take up to five to ten business days. Once approval is received, PrimeMail will ship your medicine. If we are unable to get an approval from your prescription drug plan, PrimeMail will notify you about the denial.

    Prescriptions can be profiled at the request of the member. You could choose this option if you still have medicine on hand and do not require any more until a later date. When you are ready to get the prescription filled, call Member Services at 877-357-7463 or visit MyPrimeMail.com to start your order.