Medicare Part D Services

ProCare Rx has the most complete Medicare Part D service package to manage all of your CMS needs. We guide our clients effortlessly through the complexities of Part D and PDE submissions and have a proven track record of successful Medicare implementations.

Custom Part D Formularies

At the inception of Medicare Part D, we developed the ability within our claims processing system to support a multitude of Part D Plan Benefits. Our proprietary and flexible system can react instantly to meet a client's specific benefit design needs. We support and manage any Part D custom formulary, or a client may choose from a variety of formularies we have already developed that are CMS compliant, provide lower net cost alternatives, maximize rebate compliance and returns, and provide a wide array of drug products.

PDE Success

Many Medicare Part D clients require their PBM to generate PDE (Part D Drug Event) files on their behalf. ProCare Rx provides our Part D clients PDE files, in the published CMS formats at the frequency that meets our clients' needs. Our claims processing application contains built-in edits to ensure the accuracy of data calculation of PDE financial fields at the Point of Sale.

A Bonus for Beneficiaries

ProCare Rx is able to reimburse Medicare beneficiaries when an eligibility error or retrospective eligibility change has occurred. If the beneficiary has overpaid due to incorrect cost share amounts, a member reimbursement check is queued for distribution.

Part D Personal Support

To further complete our Medicare Part D service package, we provide the ability to process complex Part D copayment calculations and coordination of benefits for our clients, member EOB generation, CMS compliant files for Medicare Part D reporting and automated Financial Information Reporting (FIR) to support plan to plan TrOOP and drug cost data exchange. With almost three years of experience as a full-service PBM for direct contracted MA-PD and PDP Plan Sponsors, ProCare Rx provides designated CMS specific Account Management staff to support our Medicare Part D accounts. Our Director of Compliance is focused exclusively on monitoring CMS compliance initiatives-bringing our clients true peace of mind.

Medicare Part D is here to stay, and ProCare Rx will work diligently to put your company at ease despite the regulatory challenges you face by simplifying a complex process.