1. Coverage Questions
Q: Is my medication covered? How much does it cost?
Members can check the patient portal; non-members, please contact our patient care team at info@pcarx.com or (855) 882-7499 .
Q: My medication is not covered, what do I do?
Contact PCA Rx at (855) 882-7499 or info@pcarx.com to verify coverage. If your medication is non formulary, we will provide you with formulary alternatives. You may have your doctor submit a request for medical necessity review.
Q: What is a deductible?
The amount the patient is responsible for before insurance covers any prescription cost.
Q: What is my deductible?
Please contact PCA Rx at (855) 882-7499 or info@pcarx.com to verify.
Q: What is a Maximum Out-of-Pocket (M.O.O.P.)
The max dollar amount the patient will have to pay in a plan year for their prescription cost.
Q: What is my M.O.O.P.?
Please contact PCA Rx at (855) 882-7499 or info@pcarx.com to verify.
Q: How can I submit a claim for direct reimbursement?
2. Pharmacy Questions
Q: What pharmacy can I use?
We are contracted with 62,000+ pharmacies nationwide. Specialty medications may be limited to a specialty network. Please contact PCA Rx at info@pcarx.com to verify.
Q: Do you have a mail order pharmacy?
4URx pharmacy is our preferred mail order pharmacy.
Q: How do I transfer prescriptions to the mail order Pharmacy?
Please contact 4URx pharmacy at (888) 708-4879 with questions regarding the transferring of prescriptions.
3. Prior Authorization
Q: What is a prior authorization?
A clinical review to ensure medications are medically necessary and appropriate for the reason prescribed.
Q: How can I assist with the prior authorization?
Obtain a Prior Authorization form and ensure that your prescriber completes and returns it to PCA Rx at the fax number: (210) 783-8161.
Q: Where do I find the forms?
Q: Why do I need a prior authorization, I’ve been taking this prescription for years?
Prior Authorization must be renewed every 6 to 12 months and/or start of a new insurance policy.
