Physician Performance Insights Reports Are Now Available

PPI reports are available for physicians who are eligible for our Physician Efficiency, Appropriateness, & Quality^SM program. Learn what the reports include on performance and how the ratings can help our members find care.

Watch for Our Provider Advisory Survey

The information you provide helps us better serve both you and our members.

Shared Decision‑Making Aids Can Help Guide Care Choices

Our members may have better patient experiences and outcomes when they participate in their care. Learn about evidence‑based aids that can help involve your patients.

Earn Continuing Education Credit at Maternal Mental Health Webinar

On Sept. 9, 2024, we’re offering a free webinar on maternal mental health from 9 to 10 a.m. Register here  and learn more about our behavioral health webinars.

Register for Webinars on Coding for Cancers, Stroke and Heart Failure

Join our Coding Compliance team for webinars in September and October on coding and documentation. The webinars are free to providers and coding professionals, and have tips on closing gaps in care.

Encourage Medicare Members to Respond to Health Outcomes Survey

The Centers for Medicare & Medicaid Services sends a survey to a sample of our members to rate their care. Learn about the survey topics our members may discuss with you.

30‑Day Supply Limit: Select Commercial Members Have New Pharmacy Benefit for GLP‑1 or Anti‑Obesity Drug Therapy

This optional pharmacy benefit program is available to some employer groups with Prime Therapeutics. Learn how it aims to reduce drug waste.

Pharmacy Program Quarterly Update Changes Effective Oct. 1, 2024 – Part 1

Based on the availability of new prescription medications and Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some additions, revisions (drugs still covered but moved to a higher out‑of‑pocket payment level) and/or exclusions (drugs no longer covered) were made to our drug lists.

Medical Policy Updates

Approved new or revised medical policies and their effective dates are usually posted on our website the first and 15th of each month under the Standards and Requirements tab. You can view all active and pending policies, as well as draft medical policies, and provide comments. These policies may impact your reimbursement and your patients’ benefits.