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RegenceRx® is
our online pharmacy benefits manager designed to assist our providers and members
with prescription benefits and other relevant information.
Not all pharmacy plans cover the same medications or cover the same medications
in the same way. The price your patient pays will depend on the pharmacy plan
they belong to, as well as the medication you prescribe.
Non-Formulary Medications
- Any medication not listed on the PML is non-formulary
- If your patient has a three-tier prescription benefit, non-formulary medications are only available at the highest copayment
- If your patient has a closed formulary benefit, non-formulary medications are only available at the member's expense
National Provider Identifier Number (NPI) and Claim Adjudication
When pharmacists transmit prescriptions electronically, the provider's NPI number is transmitted, not the provider name. It is important that the pharmacy have the correct provider NPI number associated with the prescription.
Downloadable
Forms
The following forms are available to download:
- Specialty Forms
- Mail Order Forms
- Medication Prior-Authorization Form
- Authorizations for Use and Disclosure of Protected Health Information
Information
on Generics
Help control rising health care costs by prescribing generic medications
wherever possible.
Medication
Policies
Medication Policies have been developed through consideration of
medical necessity, generally accepted standards of medical practice, and review
of medical literature and government approval status.
Preferred
Medication List (PML) / Formulary |
The PML details which medications are
covered and what copayment or coinsurance level applies. Our members
will experience the highest out-of-pocket costs when a prescription
is written and filled for a medication not on the PML.
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Prior
Authorization & Quantity Level Limits |
Some medications may have quantity limits
or require prior authorization. Prior Authorization requests may
be submitted via mail, fax or online.
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| Medicare
Part D Prescription Programs |
The Medicare PML details which medications are covered
and what copayment or coinsurance level applies. Additionally, some
medications may have quantity limits or require prior authorization.
Prior Authorization requests may be submitted via mail, fax or online. |
RegenceRx
Provider Resources |
These services are intended to offer:
- Possible therapeutic alternatives
- Potential costs of prescription medications
- The latest clinical information on prescription medications
- Alternatives to minimize your patients' out-of-pocket expenses
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Special
Member Programs |
RegenceRx has several special member
programs that offer valuable information, cost savings and new ways
to manage how prescription dollars are spent. |
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