Pharmacy Resources
Find the information, forms and support you need to submit claims, address reimbursement questions and work with PharmPix.
PharmPix Pharmacy Provider Manual
The complete reference for participating pharmacies: claims submission and reversals, utilization review, network requirements, audit and compliance obligations.
Pharmacy Forms & Documents
Complete a form, submit a request, or download the document you need, grouped by task.
Everything you need to submit a claim or resolve one that did not pay.
Universal Claim Form
Submit a paper claim when electronic submission is not available.
Concurrent Utilization Review
The point-of-sale edits applied to your claims, and how to respond to them.
Pricing Research Request
Request a review of the rate applied to a specific claim. You will need the prescription copy and an invoice or proof of acquisition cost dated within the last six months.
Join the PharmPix network, or keep your participation current.
How to Join the Pharmacy Network
Who is eligible, what participation requires and what happens after you apply.
Network Participation Application
Apply to participate. Retail, mail order, home infusion and specialty pharmacies are eligible.
Credentialing & Recredentialing
What credentialing confirms, who approves it, and the two-year renewal cycle.
Pharmacy Credentialing Form
Complete credentialing for a new location, or for your recredentialing cycle.
How PharmPix evaluates drugs and manages utilization.
Pharmacy & Therapeutics Committee
How the committee reviews drugs and assigns formulary status.
Retrospective Drug Utilization Review Program
The retrospective DUR program and the interventions it may generate for your pharmacy.
Required annual training, and how to report suspected misconduct.
FWA & General Compliance Training
Required annual fraud, waste and abuse training for your pharmacy staff.
FWA Training Attestation & Log
Certify your pharmacy completed training and record who was trained.
Report Fraud, Waste or Abuse
Report suspected fraud, waste, abuse or mismanagement.
We value our pharmacy partners and are committed to addressing concerns clearly and promptly.
Pharmacy Complaint Form
Our team will review your submission and respond within 30 days whenever possible.
Reach the right team, and review the terms of participation.
Pharmacy Contact Directory
Phone, fax and email for every PharmPix team a pharmacy may need.
Pharmacy Rights & Responsibilities
Your rights as a participating pharmacy, and the obligations that come with participation.
Subscribe to PharmNotes: Clinical Insights
Every month, the PharmPix clinical team breaks down the FDA safety actions, recalls, new approvals and clinical research that can change what happens at your counter. Written for pharmacy teams and prescribers.
How can we help your pharmacy?
Questions about network participation, claims, reimbursement, or credentialing? Our Pharmacy Network team is here to help. Send us a message and we'll get back to you within one business day.
The view from inside the benefit
Expert insights from pharmacists and PBM operators with an inside view of where pharmacy decisions break down, what those gaps cost, and how they affect benefit performance.
See the whole pharmacy picture.
Send us your claims data and we'll show you the avoidable cost and clinical risk hiding in it.