Frequently Asked Questions

Transcription

1 Frequently Asked Questions What is Prim ? Prim is a full service home delivery pharmacy. Services include: Filling a new prescription(s) Refilling your existing prescription(s) Transferring your prescription(s) to or from Prim Calling your doctor for a new prescription or renewing an existing prescription Providing the following: o Online cost calculators o Drug interaction information o 24/7 access to U.S.-based pharmacy staff What does Prim offer? Prim offers mail delivery with the highest standards of quality, safety and service for your prescription drug needs. Quality Each prescription is checked by U.S.-based pharmacy staff to make sure it is right. All orders are dispensed by a pharmacist who oversees each step of the process. Convenience Orders are delivered via the U.S. Postal Service to the address of your choice. Standard shipping is included at no additional charge. Privacy Orders are handled with your privacy in mind. Prescriptions are mailed in plainlabeled packaging. No indication of the contents is on the label. Safety Tamper-evident closure helps to protect your package. The special packaging also protects your drugs from changes in temperature as it is shipped. Am I eligible to use Prim ? To determine if you are eligible to use Prim , call Member Services at the number listed on the back of your member ID card. Where is Prim located? Prime is proud to offer multiple mail facilities based in the United States. Prim Member Services is also located in the United States. How can I get started with Prim ? You can get started using any of the following ways: Call Member Services at to get your prescriptions filled using Prim Visit MyPrim .com and request new prescriptions; our highly trained pharmacy staff will take care of the rest Fill out an order form and send it to Prim with your prescription(s); order forms can be found at MyPrim .com Have your doctor fax a Prim Physician Fax Order Form (available at MyPrim .com) to the fax number noted on the form Have your doctor e-prescribe your prescription electronically 1

2 What should I do if I need my medicine immediately? Because a first fill at Prim will take five to eight days to receive, ask your doctor for two prescriptions: One for a supply to fill at a local retail pharmacy for immediate use (typically a 14 to 30 day supply) One for a 90-day supply to fill at Prim How do I use Prim services online? Register through your health plan website or at MyPrim .com. You will need your member ID number. This number can be found on your member ID card. For security reasons, you will also need to provide your name, date of birth and gender. The personal information you provide helps identify you each time you order a prescription. The information ensures that you are the only one who can access your private health information. This also makes refilling an order easier. If you prefer to not share personal information online, call a member service agent at Family members covered under your pharmacy benefit may need to register separately. Members can register for their dependents. However, state and federal privacy laws protect the prescription details of adults and dependents over a certain age. This age varies by state law. Information for dependents under this age may only be available to the policy holder. Is my information safe online? Yes. Prim protects the privacy and the security of your personal information. Your information will not be shared or sold. Prim uses state-of-the-art 128-bit SSL encryption and identity verification software to keep transactions with Prim private and secure. To take advantage of Prim s online technology, you will need a major web browser that supports 128-bit encryption (such as Internet Explorer, Firefox, Safari, etc.). What Prim materials can I find online? Once logged onto MyPrim .com you can print: Prim brochures Prim forms that you can fill out and mail in with your prescription(s) Fax forms that your doctor can use to write a new prescription and fax into Prim Prescription claim forms to submit for reimbursement for prescriptions you may have paid for without using prescription coverage You can also: Update your contact information Check on the status of an order Confirm your drug allergies View your claim history Review your health conditions Look to see what drugs are on the formulary Add or change payment options Check drug pricing Refill available prescriptions Review drug interaction information Request a renewal of an expired prescription Locate a local, participating pharmacy How can I get my prescription(s) transferred to Prim ? To get a prescription moved from a local retail pharmacy to Prim , call Member Services at

3 Prim accepts faxed or eprescribed prescriptions from your doctor for all drugs except Schedule II narcotics. For those other medicines, the paper copy is required at the pharmacy before the prescription can be filled. This is required based on federal and state dispensing regulations. Can my order be faxed to Prim ? Yes, Prim can accept faxed prescriptions from your doctor. However, Prim does not accept faxed orders from members. Please note that some state laws prohibit the faxing of prescriptions for controlled substances. Please check with your doctor. How does my order get processed? Once your order is received at Prim , the order form and prescription are scanned to keep a digital record of the order. Once the digital record is created, we will check to make sure your prescription is eligible for coverage. Pharmacy staff processes all prescriptions. A pharmacist verifies all prescriptions for accuracy. If there are any issues with your prescription, Prim will contact your doctor. If there are other issues with your prescription or with the order, Prim will make all attempts to resolve the issue. You will be notified if the issue is unable to be resolved. You may also be contacted to get additional information or clarification. Your order will be shipped after all issues are resolved and a pharmacist has verified your order. Who fills my prescriptions? All orders are processed by certified pharmacy technicians, all based in the United States. The orders are all reviewed by registered pharmacists for safety, verification of order information and accuracy. More than a dozen quality checks are conducted on each order. Medicines are checked several ways: Barcode matching Photo-imaging Weight verification Electronic tracking Where does Prim get its medicines? Prime buys its medicines from reputable, licensed drug wholesalers and manufacturers. Prime s suppliers must comply with federal tracking regulations that ensure the medication is the same product that left the manufacturer. Does the Food and Drug Administration (FDA) monitor the drugs Prime purchases? Recently, the Food and Drug Administration (FDA) has adopted more strict standards for licensing. Stronger penalties have been set for companies that create counterfeit medicine or distribute counterfeit medicines. The FDA uses state-of-the-art electronic tracking technology to follow the drug supply chain. Prim s website has VIPPS accreditation through the National Association of Boards of Pharmacy. VIPPS-accredited pharmacies must demonstrate a proven record of quality business practices in regards to patients health and safety. What medicines are available through Prim ? Prim will make all attempts to get the medicine prescribed by your doctor. If the medicine is not available through Prim , we will let you know. In some instances, with your permission, Prim can contact your doctor for an alternative medicine. 3

4 Can Prim fill my prescription with a specific generic drug or generic drug manufacturer? We can help if you require a specific generic drug or manufacturer. Your doctor must write the required manufacturer on the prescription, along with the reason for the requirement. Prim will make every attempt to get the specific manufacturer required. Does Prim fill over-the-counter (OTC) products? Prim can fill some OTC medicines if your doctor writes a prescription for it and your pharmacy benefit plan covers the medicine. OTC medicine list may vary by client. Call to find out if your OTC prescription is covered by your benefits. Does Prim fill Durable Medical Equipment (DME)? Prim will process your DME prescription. Some examples of DME include paradigm pumps and reservoirs. If your pharmacy benefit plans covers the product, Prim will dispense. Are there any medicines Prim is unable to fill? Listed below are the medicines that Prim does not dispense. These medicines may be dispensed through a Specialty pharmacy, a physician s office or a hospital: Accutane Kogenate Serostim Actimmune Leukine Somavert Amevive Nutropin Synagis Aralast Nutropin AQ Temodar Avastin Nutropin Depot Thalomide Botox injections Prolastin Tracleer Cerezyme Proleukin Tisudyne Flolan Raptiva Xeloda Fragmin Recominate Xolair Helixate Remodulin Zavesca Infergen Sandostatin Zamaira This list could change at any time. Please call Member Services at to find out if Prim is able to dispense your medicine. Can Prim fill my compound medicines? Prim can fill compound prescriptions with some limits. Certain prescriptions cannot be compounded at Prim . To determine if your prescription can be compounded by Prim , contact Member Services at What if I have questions about my medicine? Please review the drug information that was sent with your Prim order. Prim includes a Patient Advisory Leaflet (PAL) for each medicine dispensed The PAL is an informational sheet about your medicine(s) including what the medicine is for, how to store it, side effects of the medicine, and more. If you have any questions regarding your medicines please contact Member Services at where you can speak to a pharmacist. How can I get my prescription refilled? You can refill your Prim prescription: Online at MyPrim .com 4

5 Mail in the request with a Prim order form Through Prim s automated call line Speak directly with one of our Member Service agents at If my prescription drug plan does not cover my prescription but I still need it, can Prim fill it? Prim only fills prescriptions that are covered through contracted pharmacy benefit plans. For prescriptions that are not covered by your pharmacy benefit plan, you may have the prescription filled at your local pharmacy. How soon will I receive my medicine? Upon receipt of your new prescription or refill request, it may take five to eight business days for you to receive your order. How are the prescriptions mailed? Prim provides standard shipping to the address of your choice for no charge. Second day shipping is $15, and overnight shipping is $22. A physical address is required for second day and overnight shipping. We are not able to ship second day or overnight to PO Boxes. Shipping costs are subject to change. Prim provides mail-service delivery to any of the following U.S. Postal Service destinations: All 50 states APO/FPO addresses PO Boxes U.S. Territories How are temperature-sensitive medicines shipped? Temperature-sensitive medicines that require refrigeration are shipped in an insulated package via second day or next day overnight. These are shipped at no additional charge to you. To ensure the stability of some refrigerated medicines, Prim will contact you to validate the shipping address and to inform you when the package is expected to arrive. What if my doctor did not include all the information needed on my prescription? If Prim is unable to process your order due to a lack of information, we will notify you of the delay. Prim will contact your doctor to get any missing information. Our pharmacists may also contact your doctor to clarify any questions they may have. What if I want/need more medicine than my doctor prescribed? Prim can t dispense more that what the doctor has prescribed without doctor authorization. What are my options if I can t get my prescription because it is on manufacturer backorder? Prim will notify you if there is any delay in shipping your order. If the prescribed medicine is not available, please contact your doctor to discuss options. For short-term fills, you may want to check with your local retail pharmacy to see if they have the medicine available. Talk to your doctor if you need a short-term prescription. My medicine is out of stock, when can I expect it? Prim checks and stocks its inventory daily. If your medicine is out of stock and not on backorder from the manufacturer, it should be available within 1-2 business days. 5

6 Does Prim require payment when I place a request for a prescription to be filled? It is best to send along payment with your order request. In some cases, Prim can process and ship your order without payment. For example, your prescription may have a zero dollar copay. Or, the total amount of your order plus any current balance is under your allowable limit. If the total amount of your order plus any current balance goes over your credit limit, Prim will notify you to discuss payment so the order can be shipped. To find out your credit limit, call Member Services at How can I pay for my order? Prim accepts checks, money orders, Visa, MasterCard, American Express, and Discover. Debit cards for Health Savings Accounts are also accepted. Credit card information can be entered through MyPrim .com, Member Services at or provided on your order form if it is mailed. How do I know what payment amount I should include with my Prim order? To determine your copay or co-insurance for new or refill prescriptions, please contact a Member Service agent at The agent will help you determine the cost for each of your prescriptions. Why did I receive a call from Prim about payment? If you received a letter or a message from Prim , please call Member Services at Prim may be able to bill your order and send an invoice if the total amount of your order plus any current balance goes over your allowable limit. If the amount due is more than your credit limit, payment will be required before the prescription is filled. Does Prim accept coupons? Prim does not accept third party coupons. However, Prim may offer promotional coupons where legally acceptable. Prim also accepts checks from drug manufacturers. See examples: ACCEPTED NOT ACCEPTED 6

7 What is the most I can be charged for an order without my permission? Orders with a total of $ (may vary by plan) or less do not require your permission. Please be sure to check drug pricing on MyPrim .com before placing any orders. Your order can t be cancelled if it has already been shipped. Will I receive a courtesy call from Prim when my order total is over a certain amount? Prim will try to contact you if your order is being processed with a credit card and the total order charges are $ or greater. This is a courtesy call to inform you of the charges due. Prim will make two call attempts before your credit card is billed and your order is shipped. To cancel your order, please contact Member Services at If you would like your order to be shipped, no action is needed. Why did Prim charge the wrong credit card? Prim keeps the credit card(s) provided on an order form or via the web. If no payment option is listed on your order form, Prim will use the last valid credit card saved on your account. If you do not want Prim to keep this information, please contact Member Services at How can I cancel my order? To cancel your order, contact Member Services immediately at Your order can t be cancelled if it has already been shipped. How do I change the shipping address or ship method if I already placed my order? To make changes to your order, contact Member Services immediately at Your order can t be changed if it has already been shipped. If I have a new drug allergy or health condition, how do I inform Prim to update my account/profile? To update your drug allergies or health conditions, you can Mail an updated order form to Prim Update your account MyPrim .com Contact Prim Member Services at When I receive a call or from Prim about my order status, do I have to do anything? Prim makes every attempt to keep you informed through , phone calls and letters. Notification options, including how and when you are contacted, can be set on your account at MyPrim .com. You can also choose how you would like to be contacted on your order form. Auto-notifications are sent: When your order is received If there are any delays in your order prior to shipping When your order is shipped Delays in your order may include, but are not limited to, the following: When Prim requires clarification from your doctor When your prescription has been denied by your pharmacy benefit plan When we require additional information from you 7

8 Prim will continue to work with your doctor and pharmacy benefit plan to get any issues resolved. Prim may also contact you directly to let you know the status of your order. Prim will make all attempts to process your order in a timely manner. If we are unable to resolve issues with your order, you will be notified. Why am I being called by Prim about my diabetic supplies? Doctors sometimes write prescriptions for diabetic supplies without instructions. If you have received these supplies from Prim in the past, we will dispense what you have previously received. If you have not received any supplies from Prim before, or it has been a year or more since you have received supplies from Prim , we will contact you. You can also indicate on your order form what supplies you prefer to avoid delays in your order. Why am I being called by Prim to change my prescription to a generic drug? Prim tries to help you get the greatest savings. Switching from a brand-name medicine to a generic medicine that is equal to the brand-name medicine may result in savings. We will contact you to let you know about the cost savings you will receive by switching from a brand-name to generic. If you agree to change to the generic, we will update your prescription on file. If your doctor has written the prescription as brand only, we will call your doctor for you to ask for permission to change to the prescription from brand to generic. If approved, your prescription will be processed and shipped. If we are unable to get approval from your doctor, we will notify you. If you do not wish to receive these calls, please contact Member Services at Why am I being asked by Prim for a form of identification? Some states require a form of identification to dispense drugs that are controlled substances. Without this information, Prim will not be able to dispense your prescription. The required information may vary by state. Some examples of this identification are: Driver s license State ID Passport Social Security Number Military ID Why did I receive a call from Prim about a cold pack order (temperature-sensitive)? Prim will call you when your prescription is considered to be a cold pack medicine. These medicines require special handling. This simply means your medicine needs to remain cold. The prescription will be shipped in an insulated package with ice packs. To ensure the stability of some refrigerated medicines, Prim will contact you to validate the shipping address and to inform you when the package is expected to arrive. Why did I receive a call from Prim to verify my name and/or date of birth? Prim will make sure orders are processed for the correct patient. Occasionally, the information provided with your order may not match our records. We need to verify information with you before we can proceed. Your order can be delayed if the information you have provided does not match what your insurance has on record. If this is the case, please contact your pharmacy benefit plan to have the information updated. 8

9 What does it mean if my prescription requires a Prior Authorization or Step Therapy? When a Prior Authorization is needed, it means your pharmacy benefit plan must approve your prescription before Prim 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. Prim will work with your doctor to validate what drugs have been tried. For both Prior Authorizations and Step Therapy, Prim 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, Prim will ship your medicine. If we are unable to get an approval from your prescription drug plan, Prim will notify you about the denial. What does it mean if my prescription is profiled? Profiled means your prescription is on file with Prim . The prescription was processed but could not be dispensed at the time it was sent in. This is usually due to limits of the pharmacy benefit plan. Limits include: The prescription is not due for the next fill The prescription requires Prior Authorization or Step Therapy Additional payment information can't be obtained after call attempts to the member The shipping address can't been verified after call attempts to the member Prescriptions can be profiled at your request. 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 or visit MyPrim .com to start your order. What if my order has been shipped, but I have not received it? Transit times can vary based on how your order is shipped and your location. Prim uses the United Parcel Service and the U.S. Postal Service for many of its shipments. First Class mail may take 1-5 days, excluding Sunday. If the order was shipped via priority mail, second day or overnight, a tracking number will be available. Prim may re-process the order at no additional charge to you if the order was shipped to the correct address and the package has not been received: 18 days after it was shipped via standard shipping 72 hours after it was shipped via second day service 48 hours after it was shipped via overnight service (excluding Saturday & Sunday) You can check your order status at MyPrim .com or by contacting Member Services at Why didn t Prim use the credit I have available on my account? If no payment option is listed on your order form and you have an available credit card on file, Prim will use the credit card. If you have supplied a form of payment at the time of your order, Prim will process your order using the payment provided or any credit you may have. You may still have a credit on file afterwards. Please call Member Services at if assistance is needed. 9

10 Why did someone else in my house receive my package? There could be several reasons that your order was received by someone else. Please contact Member Services at for assistance. At what age (and for what reason) will Prim ship directly to a dependent? Orders will be sent directly to members who are 15 years of age or older. All orders for patients younger than 15 years of age will be addressed to the parent or guardian. Prescriptions received together will typically be shipped as a single return order. Why was my prescription returned to me? When a prescription has been returned to you, this means your order has stopped being processed. Reasons for this include: Certain medicines are not covered by your pharmacy benefit plan Prescription could not be filled due to lack of information from your doctor Prescription was expired Prescription was post dated Specialty medicines may not be covered by your pharmacy benefit plan through Prim Some prescriptions may require compounding that Prim is unable to do Prim can return your prescription at your request if the prescription has not been filled. Why did I receive a generic drug when I wanted a brand-name drug? Prim strives to fill your prescription as requested by you and your doctor. If you or your doctor does not indicate that the brand-name drug is needed, Prim will fill the prescription with the generic equivalent if it is available. Prim will also ship a generic drug if the brand-name drug is no longer available. Some medicines are only available as brand-name drugs because a generic equivalent has not yet been released. When this happens, Prim will fill the order with a brand-name drug. In some instances, with your permission, Prim can contact your doctor for an alternative medicine. If you have any questions regarding your order, contact Member Services at for assistance. I received the wrong medicine or medicine strength from what my doctor prescribed. Please contact Member Services at to speak with pharmacy staff. The medicine I received is not what I ordered. Please contact Member Services at for assistance to review the specifics of the order in question. The wrong doctor s name is on my prescription. Please contact Member Services at for assistance to review the specifics of the order in question. 10

11 Why is my prescription missing directions? Please look over the paperwork included with your order. If the instructions for your order are too long to place on the label, they will be included on a separate document called a Patient Advisory Leaflet (PAL). If there are no directions with your order, or if you have any questions regarding your order, please contact Member Services at Why was my order shipped to the wrong address? Orders are shipped to the address that was on the order form included with your order or on file at MyPrim .com. If there is no address on the order form, Prim will ship to the address on file. If there is more than one address on file, Prim will make two attempts to call you to check the shipping address. After two attempts your order is put on hold (profiled). Please contact Member Services at for more information. What should I do if my prescription was filled for the wrong person? Please contact Member Services at for assistance. Why am I missing some pills from by bottle or missing a bottle from my order? It is possible that part of your prescription is coming in a separate package. It may be that part of your prescription was placed on hold. Check the invoice sent with your order for more information. If you are missing medicine from your order, contact Member Services at for assistance. Why did I receive my order in two separate packages? Prim s goal is to process orders in a timely manner. In the event of a delay, Prim may split an order to ship the prescriptions that are ready. Your shipment will include documentation to inform you of the split. We will continue processing what is left of the order until the full order has been shipped. Prim will also split an order if it contains prescriptions that are certain controlled substances. You may also request that your order is sent separately. Why was my prescription bottle not sealed? Most medicines dispensed by Prim have a seal on the bottle. Certain medicines will not be sealed due to required special handling. Your medicine is safe to take if it was received in a package that does not show signs of tampering. If the package appears to have been tampered, please contact Member Services at Why was my order so expensive? Prescription costs such as copays and coinsurance may be higher for a variety of reasons such as: You may have a deductible that has not yet been met You may be getting a brand-name drug which can have higher co-pays than a generic drug You may be receiving a drug that is not on your pharmacy benefit plan How do I know what drugs are covered by my pharmacy benefit plan? Prescription drugs covered by your pharmacy benefit plan (called a drug list or formulary) can be found online at MyPrim .com. You can also call Member Services at for more detailed information about your prescription coverage and ways you may be able to save on drug costs. 11

12 Why does my medicine look different? Prim uses various manufacturers licensed in the United States for equivalent drugs. Please review the bottle and paperwork included in your package for more information. You can also contact Member Services at , where a pharmacist can answer your questions. What do I do if my package or prescription was received damaged? All prescriptions are checked and verified before being packaged. All packages are tamper resistant. In very rare cases, the package or medicines may be damaged in shipping. If your medicine has been damaged and you are not comfortable taking the medicine, contact Member Services at to speak with a pharmacist for assistance. How do I return my medicine to Prim ? Prim will only accept authorized returns. Please contact Member Services at for more information and assistance to determine if you are able to return your prescription. How can I dispose of the medicine I no longer want, need, use or is expired? Do not flush any medicine unless the label or patient information instructs you to do so. Medicine take-back programs are a good way to get rid of expired or unused medicines from your home. This helps reduce the chance that others may take the medicine by mistake. Contact your city or county government's household trash and recycling service. See if there is a medicine take-back program in your community. Learn about any special rules about which medicines can be taken back. If no medicine take-back program is available in your area, you can follow these simple steps to dispose of most medicines in your household trash: 1. Mix medicines (do NOT crush tablets or capsules) with an unpalatable substance such as kitty litter or used coffee grounds 2. Place the mixture in a container such as a sealed plastic bag or an empty can 3. Throw the container in your household trash Contact Prim Member Services at for more information. How do I dispose of syringes and needles? Discarded syringes with needles present a risk to solid waste workers. They may suffer a needle stick injury when handling your garbage. Syringes and needles should be disposed of in a Sharps container. A Sharps container is used to hold used medical waste. Sharps containers can be purchased at most drug or convenience stores. Syringes, needles and the Sharps container should NEVER be put into the trash. Contact your local solid waste disposal department or public health department. Ask for disposal instructions for your local area. You can also contact The Coalition for Safe Community Needle disposal at They can give you information on safe disposal programs in your area. You can also visit the Environmental Protection Agency (EPA) website for more information ( 12