Specialty Medication Authorizations

Prime Therapeutics reviews prior authorization requests for select specialty drugs that fall under either the medical or pharmacy benefit.

In addition to providing prior authorization, Prime Therapeutics will review claims for:

• Medical necessity
• Accurate claims submission that is consistent with treatment protocol
• Appropriateness of use (e.g. prescribing in accordance with FDA labeling)

Providers are required to contact Prime Therapeutics to obtain prior authorizations for the following lines of business:

• Commercial
• Medicaid (including Child Health Plus)
• Medicare Advantage

Important to note

• This online portal is for non-urgent requests only. Call Prime Therapeutics directly for urgent requests at 1-800-424-8231.
• View the list of drugs associated with this program.
• Our self-funded line of business is not required to use Prime Therapeutics for prior authorizations.

Benefits

• Submit requests at your convenience.
• Info gathered from questionnaires facilitates a simpler and faster authorization process.
• Receive clear confirmation that the request was submitted, complete with tracking information for requests that need additional review.
• Less paperwork with online submission, while still being able to submit clinical support documents.

How to get started

Providers can access the Prime Therapeutics prior authorization page via Independent Health’s secure Provider Portal. Once logged in to our portal, navigate to the Authorization Hub and click launch next to the Specialty Medication Authorization heading. If users have a Prime Therapeutics account for Independent Health, they can then sign in by entering their username and password.

If you already have an account with Prime Therapeutics, you can also log in directly at https://gatewaypa.com/.

Additional information about Prime Therapeutics, including instructions for setting up an account and answers to some frequently asked questions can be found here.

Questions?

Please contact the Independent Health’s Provider Relations Department by phone at (716) 631-3282 or 1-800-736-5771 Monday through Friday from 8 a.m. to 6 p.m.