Prime Therapeutics
Price Concession (DIR) Collection
Why have there been no DIR Fees noted on my Remittance Advice /
835 File for Prime Therapeutics?
Effective January 1, 2016, Prime Therapeutics implemented their
retrospective Price Concession (DIR) based on APNS Network Performance.
This is the reason why there have been no DIR fees noted on the Remittance
Advice/835 Files thus far for 2016.
The 2016 Prime
Therapeutics’ Price Concession amounts will be collected after a lookback and
review of the previous quarter and quarterly thereafter. The Price
Concession amounts are based on APNS network performance for the following
measures: Generic Dispense Rate (GDR), High Risk Medication (HRM)
Performance Rating and Prescription Drug Volume for Prime's Extended Preferred
Network. These amounts will be collected on a quarterly basis.
*Please login
to the APNS website at https://www.apcinet.com/Services/APNS/MedicarePartD/2016MedicarePartDPreferredNetworks/tabid/360/Default.aspx
to view a list of 2016 Medicare Part D preferred networks, rates &
performance criteria
APNS pharmacies participated last year in Prime’s Preferred
Network. Price Concessions were seen in the amount of $2.50 per claim on
the RA / 835 file.
For 2016, the Price Concession remains the same, $2.50 per claim
due to improved APNS Network Performance, but will be collected on a quarterly
basis following a retrospective lookback and review.
The collection for 1st quarter 2016 will take place on
June 25th and the adjustment will appear on the July 1, 2016 payment
from Prime.
For
questions or more information about the Prime Therapeutics Price Concession
collection, please contact APNS at (866) 451-4557.
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