PBM Pharmacy Providers

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with a request body that specifies how to map the columns of your import file to the associated CRM properties in HubSpot.... In the request JSON, define the import file details, including mapping the spreadsheet's columns to HubSpot data. Your request JSON should include the following fields:... entry for each column.

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with a request body that specifies how to map the columns of your import file to the associated CRM properties in HubSpot.... In the request JSON, define the import file details, including mapping the spreadsheet's columns to HubSpot data. Your request JSON should include the following fields:... entry for each column.

Pharmacy Provider Documents

Easy access to important documents

Pharmacy Reimbursement Appeals

PharmaForce provides a pharmacy reimbursement appeals process for all covered prescription drugs or devices when a network pharmacy claims it did not receive its actual cost or as required by law.

Instructions for Submitting a Pharmacy Reimbursement Appeal:

  1. Download and Complete the Form:

  2. Submission Timeline:

    • Appeals must be submitted within 30 calendar days or as required by applicable state laws. If incomplete information is received, PharmaForce will notify the pharmacy of the missing information required for appeal determination. The notification will include a deadline for providing the incomplete information.
    • Failure to provide the required information by the communicated deadline will result in an appeal denial. PharmaForce will issue a decision within 7 calendar days following the complete submission or as required by state laws. If the appeal is in favor of the pharmacy, the pharmacy must reverse and reprocess the impacted prescription claims to receive reimbursement at the new adjusted rate.

  3. Include Required Documentation:

    • A copy of your most recent wholesaler’s invoice, including the drug or device and the current price you are appealing, must be included in your submission.

  4. Contact Information for Submission:

    • Email or fax the completed appeal form, wholesaler’s invoice, and any additional information to:

For questions regarding your reimbursement appeal or prescription claim processing, contact us at the email above or call 833-379-1643.

Note: PharmaForce utilizes Medi-Span® by Wolters Kluwer as the national drug pricing source to determine the average wholesale price (AWP) of prescription drugs.

Tennessee Provider Information

According to Tenn. Comp. R. & Regs. 0780-01-95-.03, PharmaForce must request wholesaler information for each prescription dispensed as part of the claims processing for reimbursement. This information helps identify pharmacies with claims that could result in increased reimbursement when an appeal is granted.

PharmaForce reimburses pharmacies at the drug level and does not consider the wholesaler when determining reimbursement. All network pharmacies are eligible for increased reimbursement if the date of service is on or after the effective date of the increase. Pharmacies are encouraged to reverse and rebill prescriptions for increased reimbursement, regardless of the wholesaler at the time of dispensing. For reporting wholesaler information for submitted claims, contact Pharmacy Services at 833-379-1643.

PBM Contact Information

We look forward to assisting you!

PharmaForce
1950 Butler Pike, STE 262
Conshohocken, PA 19428

  • Pharmacy Services: 833-379-1643
  • Pharmacy Network: 814-393-7355

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