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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.)
Describe your provider network
How does my prescription benefit plan work?
Which pharmacies will accept my RESTAT card?
How do I request an additional or replacement RESTAT card?
The information printed on my RESTAT card is incorrect - who do I contact to have it fixed?
I lost my RESTAT card and I need a prescription right away. What can I do?
My pharmacist said my prescription was not covered. Why not?
How do I get started with mail order prescription orders?
If I order my prescription(s) through this number, how long will it take?
How can I apply for a RESTAT pharmacy card?
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
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
How does my prescription benefit plan work?
As a RESTAT plan member, you are given a RESTAT identification (ID) card that is accepted by over 63,000 pharmacies nationwide. RESTAT's ID card entitles you to receive prescriptions by paying a specific copayment amount. Your employer or health plan pays the remaining cost of the prescription.
Your health plan may also offer mail delivery of your prescriptions through a selected mail order vendor. Mail service is especially advantageous if you are taking a maintenance medication to treat a chronic condition like high blood pressure or diabetes. By ordering up to a three-month supply of medications through mail order, your copayment will likely be lower than if you purchased three separate one-month supplies at a retail pharmacy. Additionally, you will avoid frequent trips to drop off and pick up your prescriptions.
Which pharmacies will accept my RESTAT card?
RESTAT contracts with a network of national pharmacies to include all major chain pharmacies and most discount, grocery, and independent pharmacies. To find out which participating pharmacies are located near your area, please refer to your enrollment materials, access RESTAT's online Pharmacy Locator or call RESTAT's toll-free customer service telephone number printed on the back of your member ID card.
How do I request an additional or replacement RESTAT card?
To request an additional or replacement ID card, please contact your benefits office to submit your request.
The information printed on my RESTAT card is incorrect - who do I contact to have it fixed?
Contact your benefits office and provide them with the correct information. Your benefits office will update their files and forward the correct information to RESTAT for new card production.
I lost my RESTAT card and I need a prescription right away. What can I do?
In the event you misplaced or lost your RESTAT ID card, you can provide your social security number to the pharmacist, who will in turn contact RESTAT. In most cases, RESTAT can provide the pharmacist with the information required to fill your prescription.
Alternately, you can obtain your prescription by paying in full at the point-of-service, save the receipt and submit the claim for reimbursement to your health plan. Please contact your benefits office to determine the correct procedures and reimbursement amounts for your plan.
My pharmacist said my prescription was not covered. Why not?
It all depends on your benefit plan. Most prescription benefit plans help pay for drugs that treat the most frequently encountered health conditions. If your prescription is not covered, ask your pharmacist or doctor if a similar drug to treat your condition is on the plan. Nevertheless, even if your drug is not covered by your plan, you can still purchase the medication at the pharmacy's normal price.
How do I get started with mail order prescription orders?
Contact your mail order vendor from the list below. If you are unsure who provides mail order service for you today, call 1-800-248-1062 to speak with a RESTAT Customer Service Representative.
WWW.IPSRX.COM
1-800-233-3872
WWW.WALGREENSMAIL.COM
1-800-345-1985
WWW.DRUGSOURCEINC.COM
1-800-854-8764
WWW.CAREMARK.COM
1-800-841-5550
If I order my prescription(s) through this number, how long will it take?
You should typically receive your refill order within nine days from the time you submit your order by telephone or mail. Once the mail order vendor receives the prescription order, 90% of the orders are shipped within 48 hours. To ensure that your medication is received in ample time, please place your orders at least two weeks in advance to allow for mailing time and other circumstances that may require additional time to dispense the prescription. If you are prescribed a new medication that must be taken immediately, please ask your doctor to issue two prescriptions: One for a short-term supply (e.g., 30 days) to be filled immediately at a participating retail pharmacy and one for the maximum days' supply allowed (e.g., 90 days) with as many as three refills (if appropriate) to mail to your mail order vendor. Prescriptions are shipped First Class Mail or UPS when overnight delivery is required or requested. If the customer requests overnight delivery, they pay the cost.
How can I apply for a RESTAT pharmacy card?
RESTAT provides pharmacy card services for clients representing covered members, whether an employer, HMO, MCO, association or any other group that is responsible to provide prescription benefit services.
To learn more about RESTAT's prescription benefit services available to meet your needs, please contact a RESTAT Sales Manager located in your region, or contact RESTAT's Marketing department at marketing@restat.com.
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
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