Direct Member Reimbursement

Online Reimbursement Process

For eligible Tier 2 and Tier 3 prescriptions, you will pay 100% out-of-pocket at the point-of-sale and then file for 80% reimbursement (subject to your $200 deductible) with Prime Therapeutics. 

The direct member reimbursement form can now be submitted using the Prime Direct Member Reimbursement (DMR) Member Portal.

To submit a DMR claim form online, click here and select "New User" to register your account. Follow the instructions on the screen or review the User Manual below for detailed instructions.

• Prime Online DMR Member Portal
• Account Registration Instructions
• DMR Submission Instructions

Processing Time: Please note the initial processing time for reimbursements will be approximately 2-3 weeks from Prime’s receipt of the reimbursement form and required receipts. We are working diligently with Prime to streamline and accelerate the process. During this time, all reimbursements will be via paper checks mailed to your home address.

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Mail Reimbursement Process

For eligible Tier 2 and Tier 3 prescriptions, you will pay 100% out-of-pocket at the point-of-sale and then file for 80% reimbursement (subject to your $200 deductible) with Prime Therapeutics. The reimbursement request form can be found below and includes the instructions to complete and submit each eligible request. We recommend keeping a copy of each request form and receipt submitted to Prime. 

• Reimbursement Claim Form

Mail the reimbursement claim form with the original pharmacy receipt and cash register receipt to:

Prime Therapeutics LLC
P.O. Box 25188
Lehigh Valley, PA 18002-5188

Note: Tier 1 and Tier 4 medications are not eligible for claim reimbursement.  

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Example of Drug Reimbursement Process

MONTH	PROCESS
Month 1	Member pays $100 per month for prescription at pharmacy Member submits for reimbursement Prime processes reimbursement and applies $100 to deductible
Month 2	Member pays $100 per month for prescription at pharmacy Member submits for reimbursement Prime processes reimbursement and applies $100 to deductible The $200 annual deductible has now been met for this member
Month 3	Member pays $100 per month for prescription at pharmacy Member submits for reimbursement Prime processes reimbursement and pays 80% ($80) to member