Frequently Asked Questions

What is MedImpact?
MedImpact is one of the nation's leading pharmacy benefit managers (PBM), serving the prescription needs of more than 32 million Americans. In 2008, MedImpact managed more than 118 million prescriptions through its nationwide network of more than 64,000 participating pharmacies.

Our clients include Fortune 500 employer corporations, unions, managed care organizations, health plans, insurance carriers, third-party administrators, as well as local, state and federal employee programs. MedImpact bases its success on delivering products and services that provide choice and that are designed to lower overall client cost while increasing member satisfaction and quality of care.

MedImpact links patients, pharmacists and physicians together, helping ensure the appropriate use of medication for each individual based upon their personal medication profile, prescription benefit coverage, and best clinical practices. MedImpact's products, programs and services are designed to help control total health care costs, improve quality of care and increase member satisfaction.

Whom do I contact if I have questions?
Refer to the Help Desk page in the Resources for Pharmacies section.

How do I know what information to adjudicate for a MedImpact member?
Each member will need you to adjudicate specific information to access his or her prescription benefit and to determine drug coverage. Refer to the member's prescription benefit card. The prescription benefit card should contain the member's first and last name, identification number, group number, applicable RxPCN, and the MedImpact RxBIN. If you require further assistance, please contact the customer contact center toll-free at (800) 788-2949.

What bank identification number do I use for all MedImpact members?
Pharmacies should submit claims utilizing the MedImpact bank identification number (BIN): 003585. In most cases, the BIN is illustrated on the prescription benefit card following RxBIN.

How do I determine if my pharmacy participates in the network that serves a specific plan sponsor?
MedImpact customer service representatives will help determine whether a pharmacy participates in the network that provides pharmacy-related services for a specific plan sponsor.

Can you send me a copy of the MedImpact formulary?
As a third-party processor, MedImpact typically does not distribute formularies to pharmacies on behalf of our plan sponsors.

Who do I call about payment information?
Contact the pharmacy help desk at (800) 788-2949 and the call/issue will be routed to the appropriate department.

What should I do if a claim rejects for a specific plan sponsor?
Since there are multiple reasons why a claim may reject, it is best to contact the customer contact center for assistance (800) 788-2949.

By accessing that particular claim, a customer service representative can assist the caller with any additional steps that may be needed so the claim will successfully process.

How do I become a participating pharmacy provider?
You may contact our provider relations department at (800) 788-2949.

What is the co-payment amount for a specific member?
You should submit the claim through the claims adjudication system to receive the claims response, which will include the amount to collect from the member as well as information about eligibility, drug coverage, pricing, and applicable clinical programs and services. Customer service representatives at the customer contact center cannot always determine accurate co-payment information due to the variables that may impact cost share.