PFSP is under contract with several major health insurance providers, including Medicare and Medicaid. If you are dual-eligible under these or other plans, we will work with you and your providers to decide which benefits should be covered under which plan and avoid duplicating benefits under the same plan. We will determine a primary plan and a secondary plan. The primary plan will cover the benefits you are eligible for, as if the secondary plan didn’t exist. The secondary plan may be used once the primary benefits are exhausted. Our formulary support services help you determine which drugs are covered under your specific plan.
To help you manage your condition, it is imperative that we maintain complete communication with you and your medical provider. URAC stresses the importance of quality patient care, which comes from keeping you engaged with us. Our certified specialty pharmacists and technicians utilize patient text messaging and other technology to share information about your medication, billing, and real-time data that is relevant to you and your treatment. Our goal is to ensure you and your insurance provider that we have your best interests in mind and are providing the quality care that you need.
If we determine that not enough of your medication is in stock to provide a full dosage in the time that you need it, we offer partial fill services so that you can continue to take your medication as prescribed. Additionally, if the normal dosage isn’t necessary for your condition, these services help cut costs for you and your insurance provider and reduce waste.
At PFSP, our number one goal is for you to have the best therapeutic outcomes from your treatment and be on the way to daily comfort and success. We will regularly conduct assessments of your health status to make sure you are responding well to your treatment and will address any negative health effects head-on. We also stress the importance of understanding everything about your medications: from the purpose it serves, to the dosage you need, to the side effects that you may experience. It is crucial to have this understanding in order to properly treat your condition. Under MTM requirements, we also must have a close working relationship with your medical provider and make them aware of your progress with your medication. We will refer you to your provider should you be experiencing complications that need broader medical assistance.