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. You must be logged in to your Prime portal account to view the list.
• 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

Go to https://gatewaypa.com/. If you are a new user, there is an option to request access on the log in page. If you already have an account with Prime Therapeutics, you can log in.

Providers can also 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.

Questions?

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

You can also 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 5 p.m.