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Here are the answers to our most Frequently Asked Questions. If your question isn't answered, please feel free to fill out our Contact Us Form or call (RESTAT Customer Service at 800-248-1062.)
Who is RESTAT Prescription Benefit Managers (PBM)?
How does RESTAT help the client and their plan members save money on rising prescription drug costs?
How is RESTAT PBM (Prescription Benefit Manager) different from other PBM companies?
What services does RESTAT PBM provide?
How do I obtain more information about RESTAT PBM services?
Describe your provider network
Who is RESTAT Prescription Benefit Managers (PBM)?
RESTAT, LLC (hereafter RESTAT) based in West Bend, Wisconsin, began processing claims and managing pharmacy benefits in 1985, making RESTAT one of the most experienced prescription benefit management companies doing business in America today. West Bend, Wisconsin is located approximately 45 minutes northwest of metropolitan Milwaukee.
RESTAT is currently the fourth largest PBM in the U.S. as illustrated in the March 5, 2007 edition of Business Insurance, and is the largest independent PBM with no ownership in or by any pharmaceutical manufacturer or mail order prescription service. Independent from drug manufacturers and mail order service providers, RESTAT is able to provide our customers unbiased consultation. RESTATs goal is to maximize cost containment opportunities and optimize positive patient outcomes. Our philosophy is "the customer comes first." The cornerstones of our philosophy have been independence, technology, responsiveness and savings for over 20 years.
RESTAT currently services over 3,500 clients representing over 3.5 million lives nationwide. Our clients consist primarily of insurance companies, managed healthcare organizations, third party administrators, pharmacy provider groups, and self-funded multi-employer and single employer prescription drug plan sponsors.
RESTAT, LLC is a wholly-owned subsidiary of The F. Dohmen Company, a fifth-generation, family-owned business, which has been serving the healthcare industry for over 145 years. Utilizing a strategy of innovation and diligent market analysis, The F. Dohmen Company has expanded their portfolio of companies to include pharmacy technology, logistics, and prescription benefit management.
With recent acquisitions and mergers taking place within the industry, RESTAT still is and intends to remain an independent prescription benefit manager (PBM). We feel there will remain a trend among our clients to stay with an independent PBM that will offer an unbiased approach to the administering of prescription card programs.
How does RESTAT help the client and their plan members save money on rising prescription drug costs?
RESTAT utilizes a number of cost saving programs to manage drug selection, utilization, and pricing. Our net cost programs focus on the optimal pharmacoeconomic value of prescriptions. Our independent ownership keeps us free from undue influence from manufacturers, retailers, and insurers. We provide formulary management, step therapy, therapeutic interchange, prior authorization, disease management, quantity limitations, dosage optimization and other programs to help manage prescription costs. We also provide programs for distribution of specialty products and are abreast of any industry changes which may provide additional savings.
How is RESTAT PBM (Prescription Benefit Manager) different from other PBM companies?
Rebates, discounts, formularies, clinical review and other tools in the pharmacy benefits management arsenal have long served as the foundation of an innovative lowest-net-cost strategy that the nations fourth largest PBM pioneered in 1985.
In addition to competitively providing the functions of administration, network management, formulary design, rebate revenue, billing, reporting, and other basics; RESTAT brings a long history of stable, consistent service and value. RESTAT brings opportunity, value and revenue to our provider partners and continues to do so in this increasingly aggressive marketplace.
RESTAT advantages
• Our systems are reliable with less than 0.5% downtime.
• Our clinical services and formulary are focused on real cost reductions. Administering RESTATs cost containment programs can lead to savings in excess of 15% of total drug spend over the first year.
• Our customer and client service is high quality receiving a satisfaction rating of over 96% satisfied customers in 2006.
• Our staff turnover is low with a rate of approximately 3% overall.
• Our satisfaction among our clients is high. We have performed a satisfaction survey and received over 99% satisfaction results.
• Our retention is the highest in the industry.
• Our reputation is unblemished experiencing no litigations. RESTAT brings a long history of stable, consistent service and value.
We will provide the client with a wide variety of support and products such as Health Savings Account (HAS) program's, Medicare Part D and member education.
For all these reasons RESTAT is your best choice.
What services does RESTAT PBM provide?
RESTAT is a prescription benefit manager (PBM). RESTAT provides cost-effective prescription benefit services to self-funded employer health plans. These services include:
• Cost-saving plan design and prescription claim service for employers, managed healthcare plans, workers' compensation plans, HMO's, insurance companies, Medicaid, government plans, and Unions.
• A nationwide network of more than 63,000 participating pharmacies. Our pharmacy networks are designed to provide you with convenient access to chain and independent pharmacies in your area at competitive costs to your benefit plan.
• Mail service prescription delivery to your home. Mail service is a convenient delivery option for medications that treat chronic conditions like high blood pressure and diabetes. Through mail service, you can typically request up to a three-month supply at economical co-payments.
• A computerized check for potentially harmful drug interactions before each medication is dispensed.
• Recommendations for generic and therapeutic (same class) drug intervention and substitution potential that can be discussed with your doctor and which will save you and your plan prescription benefit costs.
How do I obtain more information about RESTAT PBM services?
Function
Our customer service representatives are specifically trained to handle all calls from a member or pharmacy to include:
• Member Eligibility and Pharmacy Eligibility
• Claims Processing - How to submit, Claim Reversals and Re-submittals
• Pharmacy Check Release - Reimbursement amounts, payment status, release dates
• Prior Authorizations - Early refills, vacation supplies, lost/stolen meds
• Drug Coverage - Three-tier, Drugs not covered
• Mail Order options
• Benefit Interpretation - Co-pays, deductibles, max benefit, days supply, quantity
Hours
Days and hours of RESTAT Call Center operation (toll-free)
Monday - Friday 7:00AM to 1:00AM (CST)
Saturday 8:00AM to 5:00PM (CST)
Sunday 8:00AM to 5:00PM (CST)
Contact Customer Service Representative toll-free at 1-800-248-1062.
Function
The RESTAT Marketing Department will answer inquiries on client available services and provide responses to client and broker requests for proposals.
Hours
Monday - Friday 8:00AM to 5:00PM (CST)
Contact
Wayne Kostka Marketing Manager at 1-800-926-5858 x4223
Function
The RESTAT Clinical Department provides consultant services on plan design and pharmacy network access for existing and prospective clients.
Hours
Monday - Friday - 8:00AM to 5:00PM (CST)
Contact
Patrick McComis Clinical Director and Pharmacist at 1-800-926-5858 x4241
Function
Client service representatives work with new and existing clients to implement RESTAT service and cost saving programs. They work with the employer to provide a seamless transition of new plan designs to analysis, reports and changes on renewal.
Hours
Monday - Friday - 8:00AM to 5:00PM (CST)
Contact
Kelly Rupiper Client Services Manager 1-800-926-5858 x4239
Describe your provider network
RESTAT's National Provider Network consists of over 63,000 independent and chain pharmacies. The split between chain pharmacies and independent pharmacies is 64%/36% respectively. Our pharmacy network provides members with the greatest amount of access to retail pharmacies in and outside of their geographic area. Any client, member, or pharmacy can call RESTAT and request that we add a pharmacy to our network in order to increase pharmacy access in their area. In addition, we are able to work with most custom networks as a result of our flexibility and existing contracts encompassing 98% of pharmacies in the United States and Puerto Rico.
You may find a pharmacy near you by clicking on Pharmacy locator
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