Progressive Pharmacies Managed Care Contracting service encompasses more than 500 contracts, which are aggressively negotiated, provider enrollments, and all necessary maintenance to keep your enrollments active. More Comprehensive management of the contracts can be provided when combined with Progressive Pharmacies’ Cash Management and Claim by Claim Reconciliation Services.

We collectively bargain with pharmacy benefit managers (PBMs) to obtain the most favorable contract language for your pharmacy. We also process the claims/billing information on behalf of independent pharmacies. In this scenario the pharmacy sends/transmits claims directly to the PBM, we require the PBM to send reimbursements to us as the PSAO. Once the funds are received, Progressive Pharmacies (the PSAO) will then disburse the appropriate funds to the pharmacy daily. Throughout this process we have benchmarks and monitoring tools in place to ensure compliance with the contract terms and to highlight and identify the specific claims that are being processed in noncompliant terms.

• PBM Contract Management Services includes contracts covering Prescription drug programs for: Managed Care, Commercial Insurance, Medicare Part D, Long-term Care, Medication Therapy Management programs and vaccine programs.
• Progressive Pharmacies will provide a professional review of the PBM contract to ensure that pharmacy provider rights are protected while abiding with the professional obligations of each PBM Contract.
• Progressive Pharmacies will Negotiate, Modify & Update, and Enroll Individual stores in specific PBM contracts currently held for other Progressive Pharmacies.
• Progressive Pharmacies will monitor and make their best effort to ensure timely payments from the PBM’s relative to the adherence by the PBM to their own payment processing cycles.
• Progressive Pharmacies will provide to client a PBM contract compliance manual with updates and tips on how to avoid and/or minimize PBM Audits.
• Progressive Pharmacies may review and evaluate PBM contracts not currently held by Progressive Pharmacies for you.