ProCare Rx Receives Full Certification from the Centers for Medicare and Medicaid Under 2025 Prescription Drug Event (PDE) Data Submission Guidelines
The ProCare Rx Team • November 26, 2024
ProCare Rx, a leading pharmacy claims processor, has received updated certification from the Centers for Medicare and Medicaid (CMS) 2025 Prescription Drug Event (PDE) data submissions beginning January 1, 2025. Our certification covers both the Traditional Medicare and Medicaid Plans as well as the Program of All-Inclusive Care for the Elderly (PACE) Medicare Part D. As one of the first dual-compliant providers, our customer regulatory reporting will continue to meet both current and new 2025 submission requirements.
This program-wide recertification was mandated by CMS, and included significant changes in the PDE File Layout expansion and introduction of new financial and non-financial data fields on the PDE record.
Some of the changes applicable to all Part D sponsors include:
- “Vaccine Administration Fee or Additional Dispensing Fee” (This removed reference to Emergency Use Authorization (EUA) status of oral antiviral drugs)
- “Drug Status Indicator,” determines that the National Drug Code (NDC) submitted on the PDE was an applicable drug or non-applicable drug at the time of PDE processing.
For PACE claims there are a variety of additional financial/non-financial fields and indicators that must be included in a claim:
- Estimated Remuneration at POS Amount (ERPOSA)
- Pharmacy Price Concessions at POS
- Patient Pay Amount
- Patient Liability Reduction Due to Other Payer Amount (PLRO)
- Other TrOOP Amount/Indicator
- Selected Drug Subsidy
- Reported Manufacturer Discount
- Gross Drug Cost Below Out-of-pocket Threshold (GDCB)
- Gross Drug Cost Above Out-of-pocket Threshold (GDCA)
- Low Income Cost Sharing Subsidy Amount (LICS)
- Non-covered Plan Paid Amount (NPP)
- Originally Prescribed Quantity
- Part D Model Indicator
- Medicare Prescription Payment Plan Indicator
Kristi Mitchell, ProCare Rx Vice President of Product Management and Implementation stated, “This certification is a testament to our team’s hard work and dedication. The journey to ensuring that we are able to meet the new CMS reporting requirements on behalf of our clients has been incredibly rewarding, and we express our sincere gratitude to all our clients, employees, and everyone in the ProCare Rx family for their continued support. We look forward to achieving many more milestones together in the future!”
The 2025 PDE Testing and Certification Protocol for non-PACE Part D sponsors is posted at www.csscoperations.com
About ProCare Rx
ProCare Rx is a privately held, independent pharmacy benefit manager (PBM) that has empowered healthcare and self-insured organizations since 1988. We provide fully integrated, in-house solutions—including claims adjudication, clinical program design, pharmacy network access, cost containment, and data analytics—all supported in the U.S. Our flexible, transparent model serves self-insured employers, third-party administrators (TPA), brokers, health plans, health systems, managed care organizations (MCO), unions, workers’ compensation programs, Medicare, Medicaid, hospices, and other PBMs. With a proprietary technology platform, commitment to ethical operations, and a focus on lowest net cost, ProCare Rx delivers long-term value, clinical performance, and trusted pharmacy benefit partnerships.
Media Contact:
Marc Cohen, VP, Marketing and Sales
marketing@ProCareRx.com
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