As a pharmacy that fills prescriptions for MS patients, your pharmacy should have recently received the attached communication from Prime and Benecard. This concerns settlements approved by the MS Board of Pharmacy for both Prime and Benecard at the July 11, 2024, Board Meeting. These settlements resulted from a pharmacy complaint on the required statutory appeals process pursuant to MS Code Annotated § 73-21-156. Please note that Express Scripts may have originally adjudicated these claims via the Express Scripts Network. Regardless, the filing of all appeals per the attached communication must be sent directly to either Prime or Benecard. Appeals for underwater reimbursement must include a copy of the wholesaler invoice reflecting the acquisition cost of the medication under appeal. Please note that Medicare and Tricare claims are not included in this settlement.
The notices state that you must submit any appeal in accordance with your contract terms. In addition to your invoice, required elements may include, at minimum, your pharmacy NCPDP, Rx claim number, NDC, date of service of the claim, and the purchase price reflected on the submitted invoice. You should be contacted if clarification or other information is needed.
We urge you to review your claims and file any appeals before the applicable November deadline directly with:
Prime at MACAppeals@primetherapeutics.com or
Benecard at PBF_NetworkQuality@benecard.com.
If you have questions, please contact Todd Dear at 601-899-8880 or pbmadmin@mbp.ms.gov.
Please note
Multiple pharmacists report being instructed by their PSAO to contact the Department of Insurance for help with this or related PBM processes. The Mississippi Department of Insurance has no regulatory purview of PBM activity.