If I have any questions or comments about the website not listed here, whom do I contact?
If you have a question or comment about the website, please click Contact Us at the top right of the Member Portal Home Page.
Where do I find the information needed to create an account?
The information needed to create an account can be found on your prescription card.
Why can’t I create my own password when I first create an account?
The system is set up so that you create just a user name and account, at which time the system generates a unique, randomized password. The password is sent to the email address you entered when you created the account. This is done to verify that the email address that you provided is valid. Upon receipt of the password, you can log in to the site, click the My Profile link on the right menu bar, and the Reset Password link under the Login Information section to change your password to something that you can remember.
Why does the site say that I am ineligible to create a user name?
You may be ineligible to create a user name for any of several reasons:
What if I forget my password?
On the Login page, click Click Here for Help Logging In to the right of the page. You will be asked for your bin #, card number, date of birth, and gender. A new password will be emailed to you so that you can log back in.
Can I access the website to get insurance information after I have been terminated from my plan?
No. Once you or your plan has been terminated, your subscription to the Member Portal is inactivated.
When I log in, I am shown several plans and asked to select a plan. Why does this appear?
The system has identified that you are/were active in multiple plan benefits and wants to know which plan you want to review. While this will not have any impact on the review of your prescription history, it may have an impact on the display of formulary drugs, the year-to-date expenses, and the Check Drug Pricing function.
Why does the system sometimes make me log back in?
The system deems a user session “inactive” after 20 minutes of no key strokes or mouse activity. For security purposes, the system will automatically log you off after 20 minutes of inactivity.
How do I log off the Member Portal?
On any screen you can log off by clicking Log Off at the top right of the screen.
Can I bookmark a page within the Member Portal?
No. As the Member Portal is a secure site, if you bookmark a page and attempt to return to it at a later date, you will be sent to the home page.
Why do certain prescriptions sometimes appear on my home page?
The prescriptions shown are due for refill in the near future to maintain continuation of therapy.
How do I change the email address I use with the Member Portal?
After logging in, click My Profile at the top right of the screen, and Edit User Information under the Login Information section. You can change your email address and login question if desired.
How do I change my password?
After logging in, click My Profile at the top right of the screen, and Reset Password under the Login Information section.
How do I view my spouse’s prescription history?
Under the Health Insurance Portability and Accountability Act (HIPAA), a government act that protects the privacy of healthcare information, you will only be able to see the prescription history of your spouse and any dependents over 12 years old if they have created a user name and have granted you permission to see their information. Those rights can be granted or denied by clicking the appropriate button for the appropriate family member under “Change Access” to the right side of each family member toward the bottom of the My Profile page.
Why can I only see some of my kids’ prescriptions?
Under the Health Insurance Portability and Accountability Act (HIPAA), a government act that protects the privacy of healthcare information, you will only be able to see the prescription history of your spouse and any dependents over 12 years old if they have created a user name and have granted you permission to see their information. Those rights can be granted or denied by clicking the appropriate button for the appropriate family member under “Change Access” to the right side of each family member toward the bottom of the My Profile page.
What is the difference between a new prescription and a refill?
A new prescription is an order for a medication that hasn’t been filled before under your current prescription benefit. A refill is the continuation of your existing prescription, which does not require your physician’s approval until it expires.
When looking at the prescription profiles, why can I only see some of my kids’ prescriptions?
Under the Health Insurance Portability and Accountability Act (HIPAA), a government act that protects the privacy of healthcare information, you will only be able to see the prescription history of your spouse and any dependents over 13 years old if they have created a user name and have granted you permission to see their information. Those rights can be granted or denied by clicking the appropriate button for the appropriate family member under “Change Access” to the right side of each family member toward the bottom of the My Profile page.
How is the prescription history sorted?
By default, the prescription history is sorted by prescription date, with the most recent appearing first. However, you can sort many of the columns by clicking the column header.
How do I see the dispensing prescription history or the details of a given dispensing?
You can review the dispensing history of a given prescription by clicking History on the right side of the table under the Last Filled column header. A new screen will appear showing the claim history. If you click Details in the right column, another screen will appear with the detailed information about that selected dispensing.
Where do I find the prescription instructions?
You will need to contact the pharmacy in which your prescription was filled to get prescription instructions.
What does “co-pay” mean?
The term co-pay (or sometimes co-insurance) refers to the amount you will be responsible for paying at the pharmacy counter. The amount includes your set co-pay, any deductibles, and any penalties for product selection (for example, selecting a brand when a generic equivalent was available) that were incurred. It is the amount of the prescription cost you will be responsible for under your benefit. Co-pay amounts can vary by plan, and will depend upon the design of your pharmacy benefits.
Can I refill a prescription via mail service on the Member Portal?
Yes, if you use ProCare Pharmacy Care (PPC) as your mail service pharmacy. Prescriptions that were originally filled at PPC and are eligible for refill may be refilled through the Member Portal, although the Member Portal does not verify that there are any refills actually remaining. On the Home page next to any eligible prescription, a “Click Here to Refill this Prescription at Mail Service!” link will appear. Click the link and your request will be submitted electronically for dispensing. If there are any problems, a PPC associate will contact you.
Can I transfer prescriptions to mail service on the Member Portal?
Yes, if you use ProCare Pharmacy Care (PPC) as your mail service pharmacy. Any non-controlled, maintenance prescription may be transferred to PPC for more convenient delivery. On the Home page under any prescription that is eligible for transfer, a “Click Here to Transfer this Prescription to Mail Service!” link will appear. Once you have submitted your request for dispensing, a PPC associate will contact you for financial information.
Can I refill a prescription at any retail pharmacy like Walgreens or CVS from this website?
No. This system does not tie into the voice response system of other pharmacy chains to allow for refills of prescriptions filled in their stores.
Do I need to bring my ID card to the pharmacy counter with me every time I fill a prescription?
Sometimes your pharmacy will store your ID numbers, but you should always carry your card with you to be sure, and because the pharmacist may ask to see it.
If I refill a prescription at ProCare Pharmacy Care, how can I find out when it will be shipped?
An automated display of your order status is a future enhancement. At this time, you will need to call PPC at 800-662-0586 for information about your order.
What if I need more than a month's supply of my prescription?
Contact ProCare Pharmacy Care at 800-662-0586, or mail a new prescription from your doctor to the following address:
ProCare Pharmacy Care, LLC.
2850 N Commerce Parkway
Miramar, FL 33027
Phone: 800-662-0586
FAX: 800-662-0590
What does “prior approval” or “prior authorization” mean? How do I know if this is required for my prescription?
Prior approval, also called prior authorization, means that you need to obtain approval from your health plan to receive a medication before your prescription is covered under your benefit. The reason that prior approval may be required may vary, but may include the type of medication prescribed, the type of illness the medication is treating or the frequency of administration of the drug. In most cases, the prior authorization process ensures that the right drug is being used for the condition, based on a combination of safety, cost, and effectiveness in certain conditions.
How can I find out where a pharmacy is located and get driving directions?
Click the Locate a Pharmacy link. After entering valid search criteria, when the search results are displayed, you can click the map link to open a separate mapping site window.
Why do all pharmacies not show up when I search within my ZIP code?
Only pharmacies within your plan’s pharmacy network will appear on the pharmacy listing as a result of your search. If a pharmacy is not contracted or not part of the preferred network, it may not appear in the listing.
What is a drug formulary?
A drug formulary is a list of preferred medications that are chosen by a team of medical and pharmacy professionals for their safety and efficacy. These drugs are provided at a lower cost to patients than are non-formulary medications. Formularies help keep drugs affordable by providing medications that are equally effective in treating an illness when compared to the other medications available, but are generally the more cost-effective choices.
Are generic drugs the same as brand name drugs?
Generic drugs contain the same active ingredients in the same dosage form and strength as their brand name equivalents. Like brand name drugs, generic drugs are approved by the U.S. Food and Drug Administration (FDA) for effectiveness and safety. They are required by the FDA to contain the same active ingredients and be absorbed and used in the body the same way as their brand name equivalent; however, they may contain different binding agents or food dyes. Generic drugs are usually named after the medication’s chemical name, and more than one generic manufacturing company may produce a generic drug. In contrast, a brand name drug is produced by one drug company only.
Why are generic drugs less expensive than brand name drugs?
Generic drugs are less expensive than their brand name equivalents because generic drug manufacturers do not have some of the costs associated with bringing the drug to the market or the ongoing costs of promoting these brands to physicians. Brand name drug companies have high costs associated with research, development, advertising, and marketing, while generic manufacturers do not normally have such costs. Brand manufacturers have a period of patent protection once they have a drug approved. This patent protection allows them to be the only supplier of that medication until their patent is no longer enforceable, at which time other manufacturers may apply for FDA approval. The lower costs of producing the generic drug are passed on to your health plan and to you, the patient, in the form of lower drug prices.
What does the term “preferred brand drug" mean?
Preferred brand drugs on your formulary are those that are recommended over other brand name drugs to treat certain illnesses. Even though they are brand name medications, they may be available for a lower co-pay amount when compared to other medications used for the same purpose.
When I enter a drug name, sometimes it doesn’t show up. Why not?
Check the spelling and reenter the drug name. Try typing in only the first two letters of the drug name.
Sometimes when I enter a drug name, multiple listings come up for the same drug. How do I know which one to pick?
Different listings typically appear for different dose forms (oral, liquids, injectibles, etc.) or different chemical entities (Diovan, Diovan-HCT, etc.)
When I go into formulary search, why doesn’t it allow me to look up drugs?
If your plan benefit has a formulary but is a cash program, or no formulary has been assigned to your plan, or the formulary has not been uploaded to the website, the formulary search option will not be displayed.
Why doesn't the drug I'm searching for appear at the bottom of the results screen?
On the formulary search result screen, only preferred products appear. If you want to see all drugs within the drug class you are searching, click Show All at the top right of the section bar.
How do I know what copay or what tier the drug I selected is in?
On the formulary search result screen, the listing will show whether the drug is a brand or generic drug. Additionally, the listing will show what tier the drug is on, and the generic name of the drug.
How do I get information about my drug? Does it show a picture?
When the drug search is completed, click a drug name and strength listed in the top box of the formulary search results, and a Drug Fact Sheet or “patient monograph” page will open, containing important drug information and a picture of the tablet/capsule if a picture is on file. Note: For generic drugs, the tablets may be different than they appear in the picture.
Why does a certain pharmacy always appear as the selected pharmacy?
The last pharmacy on record in which you had a prescription filled displays by default. You can change the pharmacy if you wish by clicking Find next to the pharmacy listed, and performing a search for another pharmacy.
Is the copay and price shown on the screen what I will pay at the pharmacy?
The copay and price returned is only accurate if (1) you have not had any other prescriptions filled at any pharmacy since 12:01AM Eastern Time, (2) you entered the drug & quantity correctly, and (3) you use the pharmacy you selected. The copay may vary depending on your plan benefit and the order in which you enter your prescriptions. If you have a deductible that has been crossed, the order of entry determines where your benefit is for each prescription. However, in the end, the total copay should be very close
Where can I get information about my benefits?
Under the Benefits & Coverage tab on the menu at the top of the screen, click Plan Benefit Summary. The Plan Benefit Summary displays plan deductibles and limits, retail copays, and mail order copays.
Why I can’t get a report of all of my family members?
If your spouse or any dependent over the age of 12 has created a user name and has denied you permission to see their prescriptions, these will not show up on the report. In order to change this, the dependent would need to grant you access to see their prescriptions, which can be done in My Profile.
How do I get reports for last year?
Under the Prescriptions tab on the menu at the top of the screen, click Rx Summary Report. You can run the report for the last 90 days, the last 12 months, or a custom date range.