Pharmacy Resources

Pharmacy Resources

COVID-19 testing & vaccinations

Prescryptive’s innovative technology provides pharmacists with a simplified system to help meet the growing demand for safe COVID-19 testing and free vaccinations for the public.

Pharmacy Resources - Prescryptive Health

Pharmacy benefit resources

STANDARD PLAN MEDICATIONS – Four tier formulary guide to drug coverage.
PREVENTATIVE MEDICATIONS – Find out which preventive medications are covered at no cost to members.
SPECIALTY MEDICATIONS – Learn more about which specialty medications are preferred, and the process to get started on these medications.
PRIOR AUTHORIZATION MEDICATIONS – Find out which medications, including specialty medications require a prior authorization review.
MEDICATION QUANTITY LIMITS – View the medications that have limited quantities restrictions without a prior authorization.
AGE LIMIT RESTRICTIONS – Learn which medications have an age limit restriction that requires a prior authorization.
HEALTHY VALUES MEDICATION LIST – Learn about medications that offer the best value.

EMERGENCY FILL POLICY – Learn our policy for addressing emergency prescription needs.
PRIOR AUTHORIZATION CRITERIA – Understand prior authorization review policies.

EFT/ACH FORM – Fill out to receive payments for all claims electronically via ACH.
PHARMACY ENROLLMENT FORM – Fill out to join our national network.
PHARMACY APPEALS AND GRIEVANCES FORM – Fill out to provide documentation for appeals and grievances.
TENNESSEE PHARMACY REIMBURSEMENT APPEAL FORM – Complete form for all prescription drugs or devices in Tennessee for which payment received is less than actual cost.

PRESCRYPTIVE PHARMACY PROVIDER MANUAL – Provides regulatory, administrative, and billing guidance to pharmacies in the Prescryptive network.
PRESCRYPTIVE PRICING PAYER SHEET – NCPDP requirements for submission of cash claims for adjudication.
PRESCRYPTIVE HEALTH BIN 610749 PAYER SHEET – NCPDP requirements for submission of PBM claims for adjudication to BIN 610749.
PRESCRYPTIVE HEALTH BIN 025953 PAYER SHEET – NCPDP requirements for submission of PBM claims for adjudication to BIN 025953.

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