At Leadway Rx, we want to partner with our provider pharmacies to ensure our members are provided the best possible pharmaceutical care. Our leadership also understands that part of ensuring our members are taken care of, is making sure our network pharmacies are taken care of. We never want any of our network pharmacies to lose money taking care of our members. To ensure this doesn't happen, we contract with our network pharmacies to reimburse at competitive but fair reimbursement rates. If, however, there is an occasion where your pharmacy feels the contracted rates were not applied correctly or if you are underwater on a prescription claim for any of our members, we will remedy the situation as quickly as possible. If this does happen, please reach out to us to let us know, fill out this "Pharmacy Complaint Form", and attach the pharmacy invoice showing the price you paid for the member's medication. We will respond to your request within 5 days, and, should it be found that a reimbursement error or an underwater reimbursement did occur, we will work with you to rectify the claim immediately. Tennessee pharmacies click here for a more detailed view of the Reimbursement Appeal Process.

Each individual plan may be different in regards to the exact prior authorization review process. Call our helpdesk at 888-878-7855, and we'll let you know the process for the member's individual plan of the claim that you are trying to process. You can also get a quickstart on the process by filling out our Prior Authorization Form.

We are always looking to expand our network and partner with innovative pharmacy providers to provide innovative personalized care to our members. We truly care for our members and want them to receive the pharmaceutical care they deserve! Please call (888-878-7855) or email us (info@LeadwayRx.com), and we'll send you a copy of our Pharmacy Provider Network Agreement for your team's review.

Our current payer sheet is attached here. If you are still having any issues submitting electronic claims to us or have any questions, don't hesitate to call (888-878-7855) or email us (info@LeadwayRx.com), and we'll be glad to help out any way we can.

A Preferred Drug List is a list of medications selected for coverage primarily based on safety and efficacy. Cost to the member, as well as cost to the plan sponsor, can also go into the formulary development process, especially in instances where there are multiple drug products to choose from in the same medication class. The Preferred Drug List will include brand name, generic, and specialty medications. As new drug products come to market, and improved/updated therapeutic guidelines become available, it is necessary to add or remove certain medications from the Preferred Drug List. Because more research and drug information continually become available, this list will always be a work in progress, but we will always alert you if our changing of the Preferred Drug List is going to affect you and the medications that you take.

A prior authorization is an extra step that some medications are required to go through in order to be covered by your drug plan. Prior authorizations are often required on medications that have a high chance of being abused, being prescribed for off-label (not FDA approved) indications, or for medications with exceptionally high prices. These are tools used by plans to ensure that the medication is being prescribed appropriately, and that there isn't a better suited alternate therapy. While each plan is different and often-times will require different steps, our standard "Prior Authorization Form" can be found here.

Your pharmacy should be able to pull anything they need from your insurance card. If, however, they are still having issues or you don't have a copy of your insurance card; either you or your pharmacy are welcome to call (888-878-7855) or email us (info@LeadwayRx.com) and we'll be happy to get you/them all of the information they need to submit claims to us electronically.