Pharmacy Networks

MC-Rx manages hundreds of networks for our clients.  We process claims online and in real-time for the entire network and reimburse pharmacies on regular payment cycles.  Our networks are fully credentialed to ensure all insurance, licensure, and quality measures are compliant with MC-Rx standards.  Our Pharmacy Audit and FWA team also monitors pharmacy activity and performs both desktop and on-site audits, which result in a sentinel effect for pharmacy behavior.

MC-Rx offers a national pharmacy network of approximately 68,000 pharmacies that provides full access for plan participants.  This base network is available for both Commercial and Medicare programs.  The network includes all major chain pharmacies and PSAOs (Independent Pharmacy Affiliations) and most individual independent pharmacies. MC-Rx also offers the option of custom, client contracted pharmacy networks and can furthermore utilize our pharmacy network options and create closed, pocket, or wrap networks where our pharmacy network “surrounds” the client network. 

MC-Rx offers six (6) primary pharmacy network options that can vary from group-to-group and plan-to-plan, and any of the six options can support a pocket or wrap network with varying benefits and coverage.

• National Open Network:  A network offering competitive pricing using the full pharmacy network and most pharmacies in the United States and its territories.
• National Restricted Network:  A network offering more competitive pricing that excludes one large national chain pharmacy.  
• National Narrow Network: A network offering more competitive pricing that excludes two large national chains.
• Medicare Open Network:  A network meeting all CMS requirements for Medicare and offering competitive pricing using the full pharmacy network and most pharmacies in the United States and its territories.
• Medicare Preferred Network:  A network offering more competitive pricing that maintains a copay differential at one large national chain pharmacy.
• Medicare Narrow Choice Network:  A network offering more competitive pricing that maintains a copay differential at two large national chains.

The savings generated by the networks above are based on competitive discounts, including aggressive MAC pricing for generic drugs.  

The Restricted, Narrow, and Preferred networks enhance discounts through negotiated reimbursement improvement and a shift in pharmacy utilization mix to more favorably priced pharmacies. 

Savings from Pharmacy Usual and Customary pricing normally exceeds fifty percent (50%). Savings from competitors’ networks, regularly demonstrated by price comparisons, is ten percent (10%) to thirty percent (30%).

• Workers Comp Network
• Hospice Network 
• NADAC Network for Cost Plus Pricing 
• Pharmacy Discount Card Networks
• 340B-Based Networks