Standard requests are completed within 3 business days and urgent requests within 1 business day once all required information is received from your provider. Reviews can be delayed if we do not receive all information needed to make a determination from your provider. The most efficient way for a provider to initiate a prior authorization request is through our online portal: https://proactrx.promptpa.com. Drug-specific information is incorporated into this process to help reduce the need for subsequent outreach to your provider after the request is initiated. Manual faxing of these requests can cause delays in the initiation and turnaround time of the determination.

Prior authorization requests are reviewed against both member-specific prescription drug coverage and evidence-based clinical criteria guidelines for the medication requested.Prior authorization requests are reviewed against both member-specific prescription drug coverage and evidence-based clinical criteria guidelines for the medication requested.

Reviews can be delayed if we do not receive all information needed to make a determination from your provider. The most efficient way for a provider to initiate a prior authorization request is through our online portal: https://proactrx.promptpa.com. Drug-specific information is incorporated into this process to help reduce the need for subsequent outreach to your provider after the request is initiated. Manual faxing of these requests can cause delays in the initiation and turnaround time of the determination.

ProAct’s Clinical team consists of clinical pharmacists, clinical care coordinators, clinical services specialists, and clinical services clerks who review each prior authorization (PA) request.

• Contact your pharmacy to rerun your prescription through your insurance.
• Contact your provider’s office as they will be notified via fax if the prior authorization (PA) has been approved or denied.
• Contact ProAct’s Help Desk at 1-877-635-9545.
• Check status through ProAct's PromptPA Online Portal with Episode of Coverage (EOC) Number.
   

You may be asking yourself "my provider already sent in a prescription, isn’t that authorization enough?" but that isn't always the case.

A prescription is an instruction written by a medical practitioner that authorizes a patient to be provided a medication. 

A prior authorization (PA) is a process for some medications, due to cost, type, or prescription benefit plan that require review before they are covered. PAs are designed to help prevent you from being prescribed medications you may not need, those that could interact dangerously with others you may be taking, or those that are potentially addictive. PAs are a way to help ensure that you are getting the most cost-effective drug for your condition.

First, DON’T LEAVE THE PHARMACY. In order to provide a smooth transition and prevent members from experiencing a lapse in therapy, ProAct has a one-time override policy for claims that may reject for a PA or a similar edit. Follow the workflow below.

Benefit cards will be mailed directly to the address on file with your employer prior to the effective date of coverage.

You have the option of downloading a temporary ID here in the member portal. Note: You will need to be signed in to your member account to access this feature.

Simply present your benefit card and written prescription to a participating pharmacy. Your unique benefit information (shown on your benefit card) is needed at the point of sale to properly process the claim. 

ProAct’s pharmacy network includes over 64,000 pharmacies nationwide. To check if your preferred retail pharmacy is in network, utilize the My Network Pharmacies feature in the member portal to search by address/zip and radius.

First, be sure you have provided the pharmacy with your new benefit card, especially if this is a new benefit for you. If there is still a problem with your claim or it is denied due to a prior authorization requirement, DO NOT LEAVE THE PHARMACY. You or your pharmacist should call ProAct’s 24/7/365 Help Desk (1-877-635-9545) immediately for a resolution.

You will need to download, complete and return a Direct Member Reimbursement (DMR) form. You may also obtain a DMR form by contacting ProAct’s 24/7/365 Help Desk at 1-877-635-9545.

Missing information may cause a delay in payment. Please be sure to sign the form and attach your pharmacy receipt(s) and monograph(s) for each claim. Send to:
ProAct, Inc.
Attn: DMR Dept.
1230 US Highway 11
Gouverneur, NY 13642

Reimbursement is generally based on the maximum amount allowed for the prescription less your copayment and deductible, if applicable, and may not be the same amount you paid. To avoid paying more for your prescriptions, be sure to use your benefit card at participating pharmacies.

Drug lists are typically divided into different categories or “tiers”. Usually these include: generic (tier one), preferred brand (tier two), non-preferred brand (tier three), and specialty medications (often referred to as tier four). The copay you are responsible for paying at the pharmacy is determined by what tier level your medication falls into.

ProAct Pharmacy Services is ProAct’s mail order pharmacy. ProAct Pharmacy Services will deliver maintenance prescriptions, up to a 90-day supply, directly to your door for the cost of your mail order pharmacy copay. It is reliable, secure, and convenient … and you will likely lower your out-of-pocket costs. Plus, standard shipping is free! Additional benefits include:

• The option to sign up for automatic refills on eligible prescriptions.
• For any prescriptions enrolled in Auto-Refill, the ProAct Pharmacy Services system will automatically send a refill renewal request to your physician when your prescription has no refills remaining.
• 24/7/365 access to live Help Desk representatives

We just need your prescription to get started! Ask your physician to e-prescribe a three-month supply to “ProAct Pharmacy Services”. 

Your physician may also call in, fax or mail your prescription to ProAct Pharmacy Services using the following information:
Mail: ProAct Pharmacy Services, 1226 US Highway 11, Gouverneur, NY 13642
Phone: 1-866-287-9885
Fax: 1-315-287-3330
NCPDP#: 3335468

Please note, we are only able to accept controlled substances via e-prescribe or mail.

Creating a mail order profile is easy! All you need to do is complete the online form. If you prefer, you may also print and mail the form or call 1-866-287-9885 to speak to a representative.

It is important that you provide a method of payment for your profile to complete the process. You have the option of setting up automatic billing to your credit card on file. You may also call 1-866-287-9885 to speak to a representative.

Remember: prescription medications are a qualified expense on your Flexible Spending or Health Savings Account.

You can expect your medication to arrive within 7-10 days after we receive your order.

When initiating your first prescription request through mail order, it is recommended that you have approximately 30 days of medication on hand to prevent lapse in therapy due to any unforeseen circumstances.

Yes, expedited shipping may be requested for mail order prescriptions at the time of order by calling ProAct Pharmacy Services at 1-866-287-9885. Some restrictions apply. Shipping and handling charges may apply.

You may easily check the delivery status of any order by utilizing Order History on the member portal.

Once you begin using mail order, we recommend that you check your mailbox daily. Most medications do not require you to be home at the time of delivery as they will be shipped directly to your mailbox. If you are receiving a controlled substance, a signature will be required. You may provide ProAct Pharmacy Services with an alternate address in which to ship the medication, where someone is present to sign for it. If you are leaving your residence for an extended period, simply provide us with an alternate shipping address or a one-time use address in which to ship your order(s).

You may manage your address(es) by utilizing My Addresses on the member portal.

Please note, additional documentation or notifications may be required for medications with specific handling requirements.

If your medication requires refrigeration (for example: insulin), ProAct Pharmacy Services will call you to schedule the delivery at a time when you will be home. All refrigerated medication will be delivered with temperature-sensitive packaging to ensure the integrity of the medication. Additionally, all temperature-sensitive medication is shipped overnight for next-day delivery at no additional cost.

You may request a refill by utilizing Manage My Prescriptions on the member portal, by mail or via phone.

Mail: ProAct Pharmacy Services, 1226 US Highway 11, Gouverneur, NY 13642
Phone: 1-866-287-9885

You may request a refill 21-days in advance of your current prescription running out.

You also have the option of utilizing the Auto-Refill Program. This will begin the process, for applicable prescriptions, when approximately 15% of your current prescription is remaining. If you have a prescription that is enrolled in Auto-Refill, but there are no refills remaining, our system will automatically send a refill renewal request to your physician.

Please notify us of any changes to any enrolled prescriptions such as dose, directions, or discontinuation of a product to ensure obsolete orders are not automatically filled and shipped. Pharmacy regulations prohibit the return of delivered prescription medications.

You may opt out of Auto-Refill at any time by managing your Auto-Refill Settings or by calling 1-866-287-9885.

Please note, some prescriptions, including controlled substances, are excluded from Auto-Refill. 

Yes! You may transfer eligible prescriptions by utilizing the Retail to Mail feature on the member portal. ProAct Pharmacy Services will contact your physician for approval and process your order.

You may also initiate the transfer by asking your physician to e-prescribe a three-month supply to “ProAct Pharmacy Services”. Your physician may also call in, fax or mail your prescription to ProAct Pharmacy Services using the following information:

Mail: ProAct Pharmacy Services, 1226 US Highway 11, Gouverneur, NY 13642
Phone: 1-866-287-9885
Fax: 1-315-287-3330
NCPDP#: 3335468

When ProAct Pharmacy Services receives a prescription electronically, by phone, fax or mail, we start to process your order to get it to you quickly. Your order may have been processed because:

• Your physician placed an order on your behalf.
• You may have set up Auto-Refill for your prescription(s).

Based on your prescription benefit plan, a specific brand-name or generic medication may have been dispensed. You can find out whether your prescription has been filled with a generic medication by calling ProAct Pharmacy Services at 1-866-287-9885.

Brand-name drugs have a 17-year patent that limits production to a single manufacturer. After the patent expires, other companies can manufacture a “generic” of the brand-name drug. The generic has been approved by the FDA and required to follow the same safety guidelines as the brand-name. The FDA (Food and Drug Administration) requires that all generic drugs have the same active ingredient, strength and dosage form as the brand-name drug. Generic drugs must prove to the FDA that they are the same. This is known as bioequivalence.  

Your medication may look different because a different manufacturer produced it.

Please call ProAct Pharmacy Services (1-866-287-9885) any time that you have a question regarding the look of your medication.

Your prescription label can also be useful tool. Using the sample label below for reference, verify that your prescription label has the same drug, strength and dosage form that you expected. If this is correct, then you can match the imprint that is on the physical medication with the imprint listed on your prescription label. If the imprint does not match or if the medication, strength or dosage form listed on the label is different than what you were expecting, please call ProAct Pharmacy Services at 1-866-287-9885 to verify. Please note, not all imprints may be listed on the label. 

Controlled substances are prescription medications that are regulated and classified by the DEA (Drug Enforcement Administration) due to their ability to cause abuse and dependence. A more strict set of regulations must be followed compared to a non-controlled prescription medication.

Certain controlled substances may be eligible to be dispensed through the mail order. State and federal regulations may impact the fulfillment of your medication. Please contact ProAct Pharmacy Services at 1-866-287-9885 for specific questions on the processing of controlled substances.

Yes. The medication you receive via mail order is safe to take and sourced from the same suppliers as local retail pharmacies. We maintain rigorous safety standards for the inventory in our pharmacies and only dispense medications that are approved by the FDA (Food and Drug Administration) for the US market. All drugs are approved for use in the US and must comply with FDA manufacturing standards to assure quality and product label requirements.

ProAct Pharmacy Services only dispenses medications that are approved by the FDA (Food and Drug Administration) for the US market. All drugs are approved for use in the US and must comply with FDA manufacturing standards to assure quality and product label requirements. The FDA oversees drug manufacturing and has staff in overseas regions (including China, India, Europe and Latin America) in order to expand oversight of imported medical products.

Pet health products are available for home delivery through our sister division Kinney Drugs. Powered by California Pet Pharmacy, Kittie & Burt's Pet Apothecary is fully licensed and accredited. All products are FDA and EPA approved and are the exact same products you'd get from your vet's office, but at lower prices. Visit www.kinneypetrx.com for more information. 

Specialty medications are used to treat complex, chronic conditions like cancer, inflammatory conditions, rheumatoid arthritis and multiple sclerosis. Specialty medications are typically higher-cost and sometimes require special handling and administration such as injection or infusion. Additionally, patients using a specialty medication may need careful oversight from a healthcare provider who can watch for side effects and ensure that the medication is working as intended.

ProAct’s specialty pharmacy is Noble Health Services (Noble). Our experts at Noble strive to support patients in all aspects of therapy and always provide the utmost care—from prescription needs and medication therapy management to financial guidance. Emergency, on-call support is available 24/7/365 via the toll-free number (1-888-843-2040). www.noblehealthservices.com

Physicians may mail, fax, call, or e-scribe to “Noble” (NCPDPD # 5806457). Noble starts the fulfillment process within 24 hours of receiving the prescription from your physician. 

Employees at specialty pharmacies fulfill completely different duties than a retail pharmacy by using a unique skill set to navigate the complexities between you, insurance providers, and physicians. They are patient advocates—helping with prior authorizations, copay assistance, clinical management and therapy adherence.

Your physician starts the process by sending your prescription to Noble. Noble will reach out to you to verify your information. Noble works together with your physician and ProAct to obtain the necessary approvals. Once approval is received, Noble reaches out to you to enroll you any copay assistance programs (if desired); coordinate delivery to a location of your choice; and take payment. Your prescription is filled and the medication, along with any ancillary supplies, is shipped next day delivery. It is important that someone is available to sign for the delivery as many specialty medications are shipped with manufacturer required temperature controls, such as cold packs for refrigerated items.

With Noble, you will receive ongoing support and education from the clinical team. Clinical support programs are designed to help ensure you remain adherent to your therapy regimen and in overall good health. Noble will reach out to you to ensure you are ready for a refill.

Your prescription benefit plan may allow you to receive select brand-name maintenance medications through ProAct’s international mail order partner, CANARX**. CANARX is a safe and completely voluntary option for obtaining brand-name drugs when a generic alternative is not available. CANARX currently offers a list of over 300 brand-name drugs at a $0 copay for a 90-day supply. Plus, shipping is free! Is your medication on the CANARX drug list? Go to www.CanarxSavingsProgram.com or call CANARX Customer Service at 1-866-893-6337 to find out.

Note: “New-to-you” medications should first be filled and tried domestically before ordering through CANARX.
** Please check your plan documents to see if this is available to you.

Maintenance medications are prescription drugs that you take regularly on a long-term basis. These medications treat chronic conditions or needs such as: asthma, diabetes, birth control, high cholesterol, high blood pressure and arthritis. A maintenance medication can also be a drug that you take for three to six months and then discontinue. For example, an allergy medication that you take throughout the spring and summer could be considered a maintenance medication.

Visit the DEA's website for information on the proper disposal of your prescription medications as well as the closest controlled substance disposal location to you. 

Your pharmacy benefits include free access to the ProAct Diabetes Management Program. Through the program, you will receive a FREE glucometer*, monthly diabetes-focused email communications, access to our online diabetes resource center, pharmacist telephone support and counseling, FREE first fill at mail order for generic diabetic medication (up to $50 per prescription)**, as well as 24/7 access to representatives ready to give you one-on-one attention and work with you to answer your questions. To enroll, first login to your ProAct member account and fill out the enrollment form.

*Must be enrolled in the ProAct Diabetes Management Program and obtain your meter through ProAct’s mail order pharmacy to receive product at no cost. **To take advantage of a FREE first fill at mail order for generic diabetic medication (up to $50 per medication) have your physician indicate “Diabetes Management Program” on your prescription(s).

Caring people are never more than a phone call away, any time of day. We’re always here when you need us. Support is available 24/7/365 by calling the ProAct Help Desk at 1-877-635-9545. You may also email us at: Support@ProActRx.com. You can expect a response within 24 hours.