As of August 30th, pharmacies across the nation have begun receiving form termination letters from Prime Therapeutics stating that Prime Therapeutics has made certain “enhancements” to its network participation criteria, resulting in the termination of many compounding pharmacies. These pharmacies are being notified of their resultant termination from Prime’s network due to the fact that processing compound drug claims in excess of 10% fails to comport with these “enhancements.” It is unclear whether any pharmacy was provided notice of these “enhancements” to the participation criteria prior to receiving these termination letters. Moreover, such unilateral action may not be permitted under Prime Therapeutics’ Pharmacy Participation Agreement or Provider Manual.
Frier Levitt can assist pharmacies in appeal network terminations by PBMs, including Prime Therapeutics. If you have received a termination letter from Prime Therapeutics that discusses non-compliance with certain “enhancements” to network participation criteria, contact Frier Levitt today.
