Provider Manual

Pharmaceuticals: Specialty Medications (Prime Therapeutics Management)

Last Updated on February 19, 2026

Security Health Plan of Wisconsin, Inc., collaborates with Prime Therapeutics Management (formerly Magellan Rx) to manage prior authorization (PA) and/or post-service claim edits (PSCE) for select specialty pharmacy medications. Prime Therapeutics LLC acquired Magellan Rx Management, LLC in December 2022.

For certain other specialty medications, Security Health Plan will internally complete prior authorization (PA) and/or post-service claim edits (PSCE).

To learn more about the Security Health Plan Medical Pharmacy Program with Prime Therapeutics Management see frequently asked questions.

Prior authorization lists

Please note: If a drug is denied due to the review processes outlined below any administration fee associated to that drug will also be denied.

Identifying which specialty medications require PA and/or PSCE

The Medical pharmacy authorization and home infusion webpage lists the most recent medications requiring PA and/or PSCE.

To view the full list of medications requiring PA through Prime Therapeutics Management:

Go to Select Category.
Choose "Prime Therapeutics Management Prior Authorizations" from the drop-down menu.
Click Search

To view the full list of medications requiring PA through Security Health Plan:

Go to Select Category.
Choose "Security Health Plan Prior Authorizations" from the drop-down menu.
Click Search

To search for a specific medication:

Type the drug code or generic/brand name directly into the Search field.
Click Search

Medications requiring prior authorization through Prime Therapeutics Management

Medication instructions will include "Prior authorization is required" and Contact Information will indicate: "To prior authorize, submit to Prime Therapeutics Management."
All Prime Therapeutics Management medications requiring prior authorization will also be subject to PSCE. Medication instructions will indicate "Post service claim edits are applied." (See the Post service claim edit below for additional details).

If you would like to submit an PA to Prime Therapeutics Management now, click the button.

Submit PA to Prime Therapeutics

Note: You may be asked to sign in or click a link to fill out a new provider access request.

Medications requiring prior authorization through Security Health Plan

Medication instructions will include "Prior authorization is required" and direct you to log into Security Health Plan’s provider portal or fax the completed Prior Authorization Request form to Security Health Plan.

Post service claim edits

All Prime Therapeutics Management medications requiring prior authorization are also passed through Post service claim edits (PSCE). Some select drugs will not require prior authorization. Medication instructions for specialty medications subject to PSCE only will indicate "Post service claim edits are applied" and not include "Prior authorization is required."

These medications will be subject to only PSCE—through Prime Therapeutics Management or Security Health Plan. The Categories section at the bottom of the instructions indicates whether PSCE is performed by Prime Therapeutics Management or Security Health Plan.

Additional resources

For more information about the program and how it may affect your payment, see Prime Therapeutics Management Post Service Claim Edits Program .
To view a list of the most recent medications requiring PA and/or PSCE, go to the Medical pharmacy authorization and home infusion. webpage.
To see information about step therapy, see Step therapy requirements for Medicare outpatient (Part B) medications.