Frequently Asked Questions:
What is a Pharmacy Benefit Manager (PBM)?
- A pharmacy benefit manager (PBM) processes prescription drug claims on behalf of you and your plan sponsor (usually your employer, union, etc.) In order to provide this service we contract with specialty and retail pharmacies, pharmaceutical manufacturers to provide the right balance of drug access and cost-effectiveness.
Can I still fill my prescriptions at my preferred pharmacy with Zillcare?
- Zillcare leverages a national network of 65,000 pharmacies as well as our exclusive national network of independent pharmacies to provide local, trusted, and perfectly tailored patient care to all 50 states.
What is a Prior Authorization (PA)?
- A prior authorization (PA) is a feature of your prescriptions benefit plan that requires you and your physician to obtain approval before the prescribed medication can be dispensed by a retail or mail order pharmacy. This requirement exists to prevent inappropriate prescribing of certain medications and to ensure the lowest cost alternative is used (barring medical necessity).
What is Step Therapy (ST)?
- Step Therapy (ST) is a feature of your prescription benefit plan that requires you to try another medication (usually a generic) before being prescribed the medication designated with step therapy (usually a brand name). This requirement exists to prevent inappropriate prescribing of certain medications and to ensure the lowest cost alternative is being used.
What is Quantity Limit (QL)?
- A Quality Limit (QL) is a feature of your prescription benefit plan that only allows you to receive up to the maximum dosage or quantity for certain medications (e.g. opioids). Quantity limits exist to ensure safe and effective doses are prescribed and to prevent fraud, waste, and abuse.
How can I learn more about the benefits of Zillcare?
- Learn more about the innovative methods of Zillcare by scheduling a discovery call with a member of the clinical experts in our business development department to discover how partnering with Zillcare and revolutionize your businesses healthcare program.