Health Care Cooperatives

The health insurance marketplace is changing, and ProCare Rx is proud to be an active CO-OP partner in promoting increased competition and consumer choice. We understand and share your mission of providing high quality, cost effective member-oriented health benefits. ProCare Rx believes that every client deserves to know exactly where their healthcare dollars are being spent and should be able to easily calculate their savings. This is why we are an industry leader in offering transparent pharmacy benefit management arrangements. It's been our mission to educate clients about how our lowest net cost formulary can bring significant savings in a world of spiraling prescription drug costs. ProCare Rx provides excellent, reliable prescription benefits at an unbeatable price for your CO-OP members.

A True CO-OP Partner

ProCare Rx's internally developed claims processing system works with you to give CO-OP members the prescription choices they want, at a price that you need, with the reliability and accuracy you deserve. It's that simple.

  • 24/7 Flexible Claims Processing Systems
  • Friendly and Knowledgeable Customer Service Representatives
  • Powerful Web-based Formulary Management Systems
  • Value-based Low Net Cost Formulary
  • Fast Prior Authorization and Step Edit Functionality
  • Data Integration and Predictive Modeling
  • Population Health Management Programs
  • Mail Order and Specialty Pharmacy Services
  • Class Leading Analytical Reports and Data Warehouse
  • Innovative Web-based Member Portal
  • Effective and Efficient Rebate Management System

Flexible Real-Time Technology

ProCare Rx will customize a formulary to fit your exact needs — the options are endless and the choice is yours. Our formulary approach includes a 'lowest net cost' therapy philosophy paired with pass-through pricing that has kept our clients' prescription drug spending below national growth rates for the past ten years in a row. We only charge for NET PAID CLAIMS (paid claims are +1, reversed claims are -1 and rejects are 0).  We negate the entire Rx for reversals, not just the ingredient cost.

Our internally developed claims processing system is integrated with retail, mail order, specialty drug and manually keyed paper claims; every prescription claim goes through the same real-time adjudication system. This is a huge advantage to CO-OP clients, who can customize every aspect of their benefit design, including copays, deductibles, drug utilization review, eligibility, and pricing edits.

National Pharmacy Network

Our national network of independent and chain pharmacies is 65,000+ strong, supported by our online claims processing system that provides pharmacies with real-time access to member eligibility and plan benefit coverage, clinical information and concurrent drug use evaluation.

Our clear contract has no retail or independent pharmacy pricing spread or hidden fees. CO-OP clients have rigorous audit rights to access, audit, and confirm all aspects of the full pass-through agreement.

Our Customer Care Center is USA-based and available 24/7/365. Bilingual representatives strive for a one-call resolution, and callers never receive a busy signal.

Mail Order Convenience

ProCare PharmacyCare, our full-service mail order and specialty pharmacy, brings added cost savings and convenience to your membership. We integrate all of our mail order and specialty claims into the same real-time claims system that adjudicates retail claims – ensuring prescription safety for every member of the ProCare Rx family. ProCare PharmacyCare has a prescription accuracy fill rate of 99.997%. Every medication is traceable, confidential, and shipped free of charge to your home or workplace. Refill prescriptions are shipped within 12 hours of receipt by PPC, and new prescriptions within 24 hours.

Physician providers have their own dedicated number to phone in your prescription quickly and easily. Members can phone or fax their prescriptions to ProCare PharmacyCare; refills can also be ordered through the Internet via our Member Portal. When your refill prescription is at '0', we personally call your physician to authorize more refills if necessary. That's a level of service that other mail order pharmacies just don't provide.

We can Help You become Your Own PBM!