FAQs
- Who is National Pharmaceutical Services (NPS)?
- What are NPS’s hours of operation?
- What types of services does NPS offer?
- Does NPS offer mail order services?
- How do I find out what pharmacies participate in my plan?
- What if I request a brand name medication when a generic is available?
- What is a formulary guide?
- What is prior authorization?
- What are Quantity Limits?
Who is National Pharmaceutical Services (NPS)?
NPS is a national prescription claims processor with a nation-wide network of over 63,500 pharmacy providers. NPS is a division of Pharmaceutical Technologies, Inc. and is headquartered at 13660 California Street in Omaha, Nebraska. NPS has been servicing member pharmacy benefit plans since its inception in all 50 states, Puerto Rico, and Guam.
What are NPS’s hours of operation?
The NPS Help Desk is open 24 hours a day, seven days a week. The Help Desk may be reached at (800) 546-5677. The Help Desk is designed to assist pharmacy providers, members, and plan sponsors with any issue related to pharmacy benefits.
What types of services does NPS offer?
NPS administers several types of prescription benefit programs including group health, Medicare Part D, Managed Medicaid, work related injury, health savings accounts, and consumer pharmacy benefit programs.
Does NPS offer mail order services?
Yes, and it is plan sponsor specific. The majority of NPS plan sponsors that offer mail order benefits utilize Integrated HMO PharmacySM services in Omaha, Nebraska.
How do I find out what pharmacies participate in my plan?
NPS has contracted and owned its own pharmacy network since its inception. This network connects prescription benefit plans to over 63,500 pharmacies across the country through the NPS SmartCard. All pharmacies in the network have contracted directly with us to provide a fair price for each prescription drug on the market and are represented as a key component to the solutions we offer.
We contract with independent, chain, and affiliated pharmacies for retail and/or mail order services. The NPS Pharmacy Network operates under an “any willing provider” philosophy, meaning that any pharmacy may join the network provided they sign a contract and meet specific criteria. (Click here to view our Global Pharmacy Network listings.)
What if I request a brand name medication when a generic is available?
You may still receive the brand name medication if you requested it; however, your co-payment may include additional charges known as ancillary charges. Ancillary charges are additional amounts added to your co-pay when you request a brand name product when a generic is available and your physician stated that you could use the generic product. The ancillary charge is calculated as the difference between the brand name medication and generic medication reimbursement rate for the Network Pharmacy. Ancillary charges are averaging over $25.00 per prescription.
What is a formulary guide?
The multitude of drugs available in the consumer market makes it mandatory that plans introduce a sound program of drug usage. This tool is developed to ensure members receive the best care and protection possible in a cost-effective manner. The Formulary is the cornerstone of drug therapy quality assurance and cost containment efforts; it supports and maximizes the effectiveness of prescribing guidelines and protocols for therapy. As such, the development and maintenance of the Formulary is necessarily an on-going and dynamic process.
The Formulary Guide is a continually revised compilation of pharmaceuticals that reflect the current clinical judgment of the Pharmacy and Therapeutics (P&T) Committee as they evaluate, appraise, and select from the numerous available medicinal agents and dosage forms that are considered most useful in patient care. The P&T Committee considers published scientific and clinical data, treatment guidelines, and FDA approved indications, plan utilization and cost in the selection process. It is the ultimate goal of the P&T Committee to make the Formulary Guide comprehensive, pro-active, and easy to use. It is not intended to interfere with independent medical judgment that is based upon the patient-physician relationship. The final choice of specific drug selection for an individual patient rests solely with the prescriber.
What is prior authorization?
To promote appropriate utilization, selected high-risk or high-cost medications may require prior authorization to be eligible for coverage under your prescription drug benefit. A team of physicians and pharmacists have established prior authorization criteria. In order for you to receive coverage for a medication requiring prior authorization, you must contact your plan administrator to obtain a Prior Authorization request form. Your physician may then be required to document the reason why a specific medication is required for treatment of your disease state or medical condition.
What are Quantity Limits?
Quantity limits are set on some medications to safeguard your health, to ensure that you or a member of your family does not receive a prescription for a quantity that exceeds the recommended limits. These limits are set because some medications have the potential to be abused, misused, shared, or have a manufacturer’s limit on the maximum dose. The limits are reviewed and determined by clinical staff, and the Pharmacy and Therapeutics Committee. The quantity limits are based on FDA approved dosing schedules and medical literature related to that particular drug.