Russ Cerny Joins ProCare Rx

URAC accreditation reflects ProCare Rx’s commitment to achieving and maintaining the highest quality, member engagement and experience, and operational standards for PBMs in the industry

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, a privately held leader in pharmacy claims processing, pharmacy benefit management (PBM), and clinical program design, has been empowering healthcare organizations since 1986. With offices in the U.S. and Puerto Rico, we provide customizable, cost-effective solutions tailored to the unique needs of self-insured employer groups, TPAs, pharmacies, health plans/systems, unions, and other industry leaders. Our commitment to ethical, transparent operations and long-lasting partnerships has made us a trusted partner in optimizing pharmacy benefits and clinical performances. To learn more about how ProCare Rx is bridging the gap between cost savings and clinical innovation, visit http://www.ProCareRx.com

FTC Hearing Recap: A Pivotal Moment for PBM Accountability

Setting Your Rx Coordinates: Navigating the Evolving Rx Landscape in 2024