What is PBM Plus?

PBM Plus is a pharmacy benefit management company. We are contracted by employers, insurance companies and health plans to process pharmacy claims. In addition, we provide a variety of other services for our clients. These include clinical services, issuing prior authorization requests, processing direct member reimbursements, and maintaining a nationwide network of retail and mail order pharmacies.

What are some other participating pharmacies in my area, and where are they located?

Although each plan may be different, chances are that your local pharmacy—or one nearby—is a member of the PBM Plus pharmacy network. Our member services help desk is happy to give you a list of participating pharmacies in your area. Or, you can search for pharmacies by name using our online Pharmacy Look-Up.

What's my benefit amount and copayment?

Our help desk at (800) 263-2178 can tell you your annual benefit amounts and copay requirements. You can also contact your plan administrator or employer. You may also email your questions to PBM Plus’s member services help desk at memberservices@pbmplus.com

What if I am prescribed a drug that is not on my plan’s formulary?

If your physician prescribes a drug that is not on your plan’s formulary, PBM Plus will let the pharmacy know immediately. If a therapeutically equivalent drug—which is on the formulary—is available, the pharmacist may contact your physician and either have the doctor substitute the non-formulary drug with a therapeutically safe equivalent, or may call the doctor and request a medical exception. The pharmacists’ actions depend on how your plan’s benefits are dictated. In either case, you will receive a safe, effective drug that has been approved by your doctor.

What happens if I get my prescription from a Non-Participating Retail Pharmacy instead of a PBM Plus Participating Retail Pharmacy?

Go to a PBM Plus Participating Pharmacy and tell the pharmacist where the prescription is currently on file. The pharmacist will contact the pharmacy and make the transfer for you. If you pay out of pocket expenses you may request reimbursement by submitting the Direct Member Reimbursement Form (pdf). Your pharmacy benefit may limit any reimbursements for prescriptions not picked up at a participating pharmacy. Refer to your plan benefit documents for further clarification.

How do I obtain more ID cards?

For additional or replacement ID cards, contact PBM Plus toll free at 800-263-2178 or click to request a new card online. You should receive your ID cards within 10 to 14 days following a request.

How can I keep my expenses down?

Please see these Money-Saving Tips.