Pharmacy Benefit Management (PBM) Program

Prime Health Services is pleased to make available the Prime Health Services Pharmacy Benefit Management (PBM) Program, PrimeRx. PrimeRx is tailor‐made to address the unique needs of the workers' compensation injured worker, and seamlessly offers a solution to the challenge of out‐of‐network pharmacy bills and third‐party billers.

Prime Health has teamed with Progressive Medical Inc., one of the largest and well known PBMs in the workers' compensation industry to provide an one‐of‐a‐kind, revolutionary pharmacy program. Our exclusive partnership with Progressive Medical provides the following:

• Cardless Environment: PrimeRx allows for seamless identification of injured workers at the pharmacy in a cardless environment. In the event the card is not available, our program will ensure a discount on the bill. Cards are supplied to the injured worker post first fill.
• First Fill Discounts: PrimeRx offers a proprietary ability to apply discounts below AWP on the first fill by forcing the transaction in‐network versus being processed by a third party biller.
• Eligible Employee Discounts: PrimeRx offers some of the most competitive and deepest discounts on all in‐network injured workers' bills.
• Non‐eligible Employee Discounts: PrimeRx allows for application of discounts below State Fee Schedule, to non‐eligible injured worker pharmacy claims. Discounts are provided via the Prime Health Services EDI bridge. This guarantees that virtually every bill will have a savings and you'll never have to deal with third‐party billers.
• Nationwide Pharmacy Access: PrimeRx gives access to 64,000 pharmacies nationwide including Target, Wal‐Mart, Kroger, K‐Mart, CVS, Walgreens and Safeway (just to name a few).
• Formulary Customization: PrimeRx offers complete customization of the formulary to meet the unique needs of the client by utilizing medication plans. Specific Injured Worker Notations: PrimeRx offers the ability to flag individual injured workers to require a pre‐authorization of EVERY prescription filled if necessary.

PrimeRx is the only program of its kind in the workers' compensation industry. This program stands alone in its ability to offer a discount on every pharmacy bill in a seamless, real‐time, hassle‐free environment.