About Us

Founded in 2004, Proscript Pharmacy Management LLC is a family owned limited liability company organized under the laws of the state of New Jersey and authorized to do business in the state of New York. It is a licensed, mail-order facility and pharmacy benefit manager. At its core, Proscript specializes in the administration of self-funded health and welfare pharmacy benefit plans sponsored by labor unions.

Services

In its capacity as pharmacy benefit manager, Proscript offers services in the following areas:

Prescription Benefit Plan Design & Administration

Proscript, along with its union-sponsored health fund clients, designed a benefit plan to encompass every necessary detail of pharmacy, including free generic drugs through its Mail Order service and other cost containment measures unique to the industry. 

Member Support

Proscript has a staff of experienced Member Support representatives standing by to assist its clients’ members with any issues or questions they may have.  These representatives are extensively trained on the healthcare industry as a whole and the specific plan of pharmacy benefits offered to members.  In providing this service, Proscript provides:

  • Toll-free number dedicated to the client that enables members to contact Proscript with questions regarding benefits, eligibility, prescriptions, package tracking, copayments, authorization issues and any other pharmacy issues or questions;
  • Representation, at the request of the client’s Board of Trustees, to attend membership meetings for the purpose of explaining all pharmacy benefits;
  • Assistance with the enrollment of new members and their eligible dependents; and
  • Processing of any and all written requests, issues, or comments received from covered persons, specifically all appeals of adverse benefit determinations, and forward of the same to the client in report format for review and decision by the Board.
Case Management

Cost containment is what separates Proscript from all others and the Case Management department is the catalyst.  Through concerted efforts, Proscript’s Case Management team facilitates applied cost containment strategies, continuity of medical and pharmaceutical advancements, and favorable and measurable financial results for the fund and covered persons alike. 

  • Some medications require authorization before you are allowed to fill them under the insurance plan. The plan requests what is called a letter of medical necessity.  Your physician must construct a letter detailing why the prescribed medication is necessary for you to have.  Including, but not limited to, your diagnosis, prior treatments for said diagnosis and treatment plan.
 
  • Proscript’s case management team considers each letter of medical necessity on a case by case basis. We will not allow a physician to prescribe you an over the top, expensive medical treatment if there are just as good, more cost effective treatments to try first.  This helps save your health fund money as well as keeping more money in your pocket.
 
  • Proscript works closely with Crossroads to ensure medical treatment and prescription therapy work together, hand in hand.  This service is unusual to other benefit plans and gives the patient the best all around care, while staying cost effective for the fund.
Consulting Services

Proscript has enjoyed tremendous success in cutting pharmaceutical costs for its clients and limiting the overall pharmacy spend expense to its clients. Through its years of experience, Proscript is able and willing to consult with other health funds to help achieve significant savings in the following ways:

  • Recommend and design fund and plan structure and the benefits thereunder;
  • Recommend and develop amendments, modifications, or revisions to the plan;
  • Assist in the preparation of all member communications and disclosure materials;
  • Assist in the development of language to be used in the summary plan description;
  • Provide detailed management reports, on a quarterly basis, of all benefit payments made by, or on behalf of the fund;
  • Prepare and present quarterly comprehensive benefits utilization reports;
  • Conduct comprehensive bidding, as appropriate, for network providers or other service providers, including, but not limited to discounted fee arrangements for pharmacy vendors, and make recommendations for re-hiring or retention of arrangements currently in place.
Mail Order Pharmacy Service

As part of its cost containment strategies, Proscript offers a full service, mail order pharmacy. Through this service, members are offered free generic medications on all maintenance drugs, as well as affordable brand drugs.

The Mail Order Process:

  • In providing pharmacy benefits to its clients’ members and eligible dependents, Proscript coordinates access to a Retail Network of pharmacies for the purpose of short term treatment only (30 days or less); including but not limited to control drugs, antibiotics, and trial period  fills of Maintenance Medication.
  • Maintenance Medications prescribed to treat chronic conditions that require long term treatment are dispensed exclusively through Proscript’s Mail Order Pharmacy Service.
  • As such, 90-day prescriptions must be submitted to Proscript for processing.  This can be achieved by sending the prescription directly to Proscript using the United States Postal Service, or your doctor may submit your prescriptions to Proscript via phone, fax, or e-scribe.
  • From the time Proscript receives your prescriptions to the time it is delivered to your door typically takes about a week or so.  This timely service is unheard of in the mail order industry and is yet another way Proscript demonstrates its dedication to offering the best service possible to its clients’ members and their eligible dependents.