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Claims guide – Pharmacy expenses
Claims guide – Pharmacy expenses
Pharmacy expenses your grant covers
- Medication copays, coinsurance, and deductibles for approved medications and products (in your fund’s approved list)
- View a complete list of covered expenses
Paying for pharmacy expenses
Your grant can cover pharmacy expenses during:
- Your entire grant eligibility period (12 months from approval date)
- Your look back period (6 months prior to award date)
Ways to pay for pharmacy expenses
- Use your TotalAssist Pharmacy Card. This is the fastest and easiest way to use your grant to pay for medications.
- Get reimbursed for pharmacy expenses you already paid for and did not use your pharmacy card
- Payments to you are sent in the form of check by mail, or by EFT if you have signed up for EFT.
Electronic Funds Transfer (EFT)
If you want to have reimbursements directly deposited into your checking account, sign up for Electronic Funds Transfer (EFT) with TotalAssist.
Using your TotalAssist Pharmacy Card
With your awarded grant, you will receive a personalized TotalAssist Pharmacy Card. Present the card at the pharmacy to pay for your out-of-pocket costs for approved medications. The card works like cash and will cover approved medications at the point of sale, so no additional claims are required. Your pharmacy card lists this information:
- Patient name
- Card holder number
- Your health insurance Group number, BIN, and PCN
How to use your card:
- Show your card to the pharmacy staff when filling or picking up prescriptions for approved medications.
- If ordering by phone, tell the pharmacy staff you have a Patient Advocate Foundation TotalAssist grant that covers copays, and provide the card information.
- Pharmacies can contact PDMI at 855-552-0274 if they have questions.
Where is my pharmacy card?
If you applied by phone, you will receive a copy of your pharmacy card in your welcome packet by mail. If you have a portal account, your pharmacy card information will be in your account.
How to submit a claim to get reimbursed
Claim form – when submitting a paper form by fax or mail
- Your specific claim form contains a barcode that identifies you in our system. A paper copy is included in your welcome packet in the mail. Please make copies of your barcoded blank claim form so you have some ready to use.
- Remember to sign your claim form before submitting.
Claims in your portal account
- You can complete and submit a claim in your portal account. There is no paper form for this method of submitting a claim.
- Gather required supporting documents for the claim. All documentation must include your name. Handwritten supporting documentation is not accepted.
- View list of required supporting documents
- Submit your claim in your portal account with supporting documentation attached, anytime 24/7.
– or – - Submit your claim by fax or mail. Your claim should include your completed and signed barcoded, patient-specific claim form, plus copies of your supporting documentation. Submit to:
- Fax to: 757-952-0119
- Mail to: TotalAssist, 421 Butler Farm Rd, Hampton, VA 23666
Required supporting documents for pharmacy expense reimbursement
- A copy of the prescription label or your prescription history
- The documentation must include:
- Your name
- Pharmacy name
- Date of service (DOS)
- Medication name
- Insurance coverage
- Your financial responsibility
- If paying the pharmacy directly, please include the remit address
- Register receipts
- Prescription history showing payment
Required documents if you are enrolled in a Medicare Prescription Payment Plan:
- Your name
- Date of service
- Medication name
- Receipts
- Bank or credit card statements
- Cancelled checks
- Itemized statements showing payments made by you
Need more help?
Chat live or call 866-512-3861, Mon - Fri, 8:30am - 5:30pm ET.
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