ProCare Rx is a national PBM company with over 20 years of experience in the healthcare industry.  Whether your company is large or small, we tailor our knowledge to your needs.  In fact, we pioneered the business doctrine of ‘transparency’ and are a leading advocate of ‘full disclosure’ and better reporting in the PBM industry.  It is our mission to treat our clients with integrity and a high level of customer service.

Each client works with their own ProCare Rx support team who deliver individual solutions and service for healthcare cost containment and member wellness.  We have many options readily available: flexible copays, a national retail pharmacy network, pharmacy benefit designs to include HSA and HRA plans, clinical programs, mail order and a specialty pharmacy for more complex medical conditions along with ProCare HospiceCare, a division offering palliative care medication therapy management. 

ProCare Rx also offers Medicare Part D services, simplifying and streamlining drug benefits and reporting regulations.  With this array of choices, and our own proprietary data collection and analyzing programs, every client has the unlimited potential to tailor their healthcare costs according to their individual company’s needs.

ProCare Rx Advantage

ProCare Rx has a strong information technology infrastructure and a proven track record for innovation and automation that includes:

• Time-Tested and 100% In-house Pharmacy Benefit IT Systems and Platforms
• State-of-the-Art Analytics and Reporting Capabilities
• Pioneer in the Development of Internet-based Pharmacy Transaction Switching

Comprehensive Clinical Savings Programs

Understanding and implementing an appropriate cost-sharing strategy is key to controlling your drug-spend.  The copay structure of your prescription benefit plan is the cornerstone of the many cost management programs you may choose to consider.  ProCare Rx gives you many ways to save:

• Lowest Cost Formulary
• Prior Authorization of High Cost Specialty Medications
• Step Therapy and Quantity Limits
• Therapeutic Interchange
• Generic Drug Initiatives
• OTC Switch Programs
• 6 Month Zero Copay Program

We take great pride in the overall performance of our clinically driven and financially proven formulary and our “lowest net cost of therapy” philosophy.  Clients using our formulary have maintained cost trends below inflation for the last five years. 

National Pharmacy Network

Our national network of retail pharmacies and mail order services ensures that our clients’ plan participants receive their medications in a convenient and cost-effective manner.  The ProCare Rx National Network of 56,000+ pharmacies includes independent pharmacies and all major chains.  Through this vast network of superior pharmacy providers, we provide our clients’ plan participants with local pharmacy providers within their zip code, as well as convenient mail-order service for larger quantities at a reduced cost.  ProCare Rx Customer Care Center is available to our members, physicians, and pharmacies 24/7/365.  We employ a bilingual staff (Spanish, plus other languages upon request).

ProCare PharmacyCare

ProCare Rx wholly owns and operates its own mail order and specialty pharmacy facility, ProCare PharmacyCare, located in Miramar, Florida.  Our pharmaceutical facility is fully integrated with our clinical department and our claims processing system, so that retail claims can be evaluated with mail dispensing.  This provides a variety of unique benefits to our clients and members:

• ProCare PharmacyCare  has a 96% customer satisfaction rating, and every order is traceable, confidential and shipped free of charge to every member
• Rapid prescription turnaround time of 24 hours
• “One-stop shopping” for 90-day medications, specialty products, diabetic supplies and OTC items
• Free bottle of 100 count sugar free multi-vitamins shipped with all new customer orders and diabetic supply orders
• Diabetic members are targeted with a mailing that offers free AccuChek glucometer and vitamins with cost reduction of up to 40% to the plan
• Fully integrated IVR system for 24/7/365 refill access

We provide members with comprehensive specialty pharmaceutical care and superior clinical services in order to help them most effectively manage their illness.

Member Web Portal

ProCare Rx built our website and developed our member portal with our customers in mind.  We deploy our portal as ProCare Rx branded, client branded, or co-branded depending on the specific needs, budgets, and desires of our clients. 

The website is designed to provide members with easy access to prescription related information in a secure environment.  Here are just some of the services that members can enjoy:

• Review their eligibility status and that of dependents
• Look up plan benefit information (copays, drug formulary, etc.)
• Find generic alternatives to brand drugs
• Transfer maintenance or specialty pharmacy prescriptions from a retail pharmacy to ProCare PharmacyCare 
• Renew a prescription or review the order status of a mail service prescription being filled at ProCare PharmacyCare
• Order vitamins or other OTC products from ProCare PharmacyCare
• Review prescription claims history or individual prescriptions
• View TrOOP accumulation status (for Medicare Members)
• Price a prescription before taking it to one of our 56,000 pharmacies
• Locate pharmacies within a zip code or radius

Medicare Part D Services

ProCare Rx has one of the most complete Medicare Part D service packages you will ever need.  Real-time claim processing with complex Part D copayment calculations and coordination of benefits; member EOB generation; and Part D file creation in CMS-ready format that includes prescription drug events, plan finder files, and formulary files – the choices are endless.  We also support Medicare Part D reporting, claim corrections and resubmission, building and maintaining Part D formularies, and plan to plan TrOOP/EOB transfer.

Only ProCare Rx has created proprietary software applications that help you fully comply with all Medicare regulations – ProCare Rx PDE Manager and Formulary Manager.  Plus, our proprietary Retro LICS software automatically tracks beneficiaries’ Medicare Retro LICS changes and any surplus checks are in the mail. Managing a Medicare Part D population has never been easier!

What Clients Are Saying About Us

They provide flexible and dynamic systems . . .

"The ProCare Rx system provides tremendous flexibility in benefit design, in addition to protocol and step therapy initiatives.  This allows us to focus our efforts on inappropriate utilization with minimal impact on members, pharmacies, and physicians who are following the protocols.  The real-time reporting capability allows us to quickly monitor trends, identify issues, and adjust interventions as needed."
Provider Relations, Large Healthcare Provider

They provide high quality customer service . . .

"We are very pleased with the supportive, professional staff at ProCare Rx.  They understand the complexities of pharmacy benefits and transactions, the day-to-day operations of a pharmacy, and the types of problems to anticipate."
Provider Relations, Large Healthcare Provider

Innovation, Information, Reliability and Integrity, Procare Rx Is Ready To Serve The Distinctive Needs Of Your Company.