Pharmacy + provider tools

Explore resources that simplify reimbursement, credentialing, and operational management.

Operational & financial essentials

Access these key tools and documents to support your pharmacy’s financial and operational success with Prime Therapeutics (Prime):
  • Specialty fee schedule(s)
  • Prime's Pharmacy Match specialty base rate list
  • 835 health care electronic remittance advice
  • Electronic funds transfer (EFT)
  • Prime’s Credentialing Threshold

MAC pricing resources

Access tools and documentation to help your pharmacy understand and manage maximum allowable cost (MAC) pricing, including Prime’s MAC list and related reimbursement guidance.

Provider contracts

Access key materials that support participation in select areas of our provider network. This may include contract documents, addendums, and contact information for contracting support—where applicable.
Sign in or register to access MAC pricing resources.
Effective September 26, 2025, users will transition to a new, self-guided registration process to establish login credentials. You can view full details by visiting: https://uac.primetherapeutics.com/help

For existing MAC List users:
  • You will use the email address associated with your current account as your login name.
  • You will receive a secure email from our Okta system with a link to set your password.
  • The link will be valid for 7 days from the date of the message.
  • Simply click the link and follow the instructions to create your password.
  • If you experience any issues with the link, please contact us at: UACSupport@PrimeTherapeutics.com

MAC appeal submission requirements

A pharmacy may submit a MAC pricing appeal via:
 
  • Fax at 877-823-6373. If a fax is sent, an email address is required so a response may be provided.
  • Phone Monday through Friday 6:00 AM – 2:00 PM PST at 888-277-5510 Option 1
  • Mail to: Attn: MAC Appeal-2900 Ames Crossing Road-Eagan, MN 55121
*If the claim is hitting an Express Scripts contract between the pharmacy and Express Scripts the appeal must be submitted via: prc.express-scripts.com.
 
The following information needs to be provided in order to initiate the appeal process:
  • A copy of the original invoice that contains the purchase price of the drug being appealed.
  • Pharmacy NPI or NCPDP, member ID, Rx #, and date of fill.
  • Generic drug name, and NDC #
  • Brief explanation as to the nature of the appeal.
The sources currently used to determine MAC pricing are McKesson, Cardinal, Amerisource, and Anda wholesale price lists, and National Average Drug Acquisition Cost (NADAC) published by CMS. Medi-Span average wholesale pricing (AWP) is currently used to calculate MAC rates. Prime reserves the right to change any pricing source at any time.
 
Once a MAC pricing appeal is submitted, the MAC Pricing Specialist will investigate the claim and proceed based on the following situations:
 
  • ALL submitted and verified MAC related appeals will receive an email confirmation that the appeal has been entered into the database and will be reviewed for a MAC pricing change within 7 business days, unless another time period for review is specified by applicable law.
  • Appeals submitted for drug NDC’s that are not on the Prime Therapeutics MAC list or a claim that has been entered as usual and customary and/or submitted will be returned as a non-MAC related issue and appeal will be closed.
  • The appeal will remain on file for continual review for up to 90 days.
Prime will notify the appealing pharmacy within 3 business days that the appeal has been received and is being reviewed.

Access executed contracts

State-based pharmacies can access their pharmacy benefit network contracts through our secure portal. This includes all applicable contract documents and legislative addendums.

For questions concerning reimbursement appeals, please reach out to us directly.

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