Medical Drug Prior Authorizations (Prime Therapeutics)
This program is administered by Prime Therapeutics and is responsible for reviewing and approving these drugs.
When Prior Authorization Is Required by Prime Therapeutics
Prior authorization is required by Prime Therapeutics when the drugs are administered by practitioners in the following places of service (POS):
- Specialty Drug Prior Authorization Criteria
- Non-specialty Drug Prior Authorization and Step Therapy Forms
Who The Program Applies To
The program applies to members enrolled in the following plans:
- Paramount Employer Sponsored Employee Medical Benefit Offerings (Commercial)
- Paramount Elite (Medicare Advantage)
- Paramount Advantage (Medicaid)
- Paramount Exchange
- Paramount ACA/ Alliance Small Group
Prime Therapeutics Self-Service Provider Portal
Providers directly contracted with Paramount may create an online account for in-scope Prior Authorizations by visiting MrxGateway.com and clicking "Provider Portal Quick Start Guide".
For Urgent or Expedited Requests
Call Prime Therapeutics at 800-327-3974. Prime Therapeutics Management has staff available 24 hours per day for urgent requests by phone (including after hours, weekends and holidays).
For Drugs Not In-scope
Please visit Prescription Drug Benefit.
Have Questions?
If you have claim, benefits, and/or eligibility questions, please call Paramount: 888-891-2564 Monday through Friday from 8:30 a.m. to 5 p.m. EST.
Notice
Effective January 1, 2021, providers may begin contacting CVS Caremark to obtain prior authorizations for ProMedica Employee Health Plan members receiving specialty drugs. Please fax all specialty pharmacy prior authorization requests for ProMedica Employee Health Plan to 866-249-6155. If you have any questions, please call CVS at 866-814-5506.
Helpful links