Get started with Prime
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Getting started with Prime

How does a pharmacy plan work?

When you visit your doctor, he or she may prescribe medicine for you. Here's how the plan works:

  • Take your prescription and member ID card to the pharmacy to get your medicine.
  • The pharmacist fills your prescription and checks with your pharmacy plan to see how much to charge you for your prescription.
  • Because you have a pharmacy plan, you may pay less for your medicine - the amount you pay is called your cost-share. Your pharmacy plan pays the rest.
  • Depending on how your health plan is designed, you may have to pay the full cost at the beginning of your plan year, until you meet your deductible. A deductible is the amount of money that you pay out-of-pocket for covered services, before your plan starts to pay.

How do I know which forms I need to fill out?

You can find the forms you need to get started on the Forms page. 

What should I do after I enroll?

Step 1:

See if your medicines are on the drug list and your pharmacy is in Prime's network:

  • Find your medicines with our Medicine Finder. If you don't see your medicine on the drug list, talk to your doctor about switching to a similar medicine.
  • Find a network pharmacy near you with our Pharmacy Finder. You can use a non-network pharmacy, but you may pay more for your medicine.

Step 2:

Review requirements for medicines you take. Some medicines on the drug list have special requirements. If your medicine does, talk to your doctor. You may be able to choose a different drug, or you could ask for approval for your current medicine.

  • Prior authorization - approval is needed before a medicine will be covered. If your medicine does, talk to your doctor. You could choose a different drug. Or, ask for approval for your current medicine.
  • Step therapy - you may need to try a different medicine first. Some drugs aren't covered unless you try another FDA-approved drug first, or your doctor submits an authorization request to Prime.
  • Quantity limits - limits how much medicine can be in each fill. Each prescription can only be filled for a specific amount, for example, 14 capsules for 7 days. If your doctor thinks you need a larger supply, he or she must ask for authorization from Prime.