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Key Notes about Insurance Contracts and Licensing when Starting a Pharmacy

We have now helped to start over 100 pharmacies. As such we have experienced a lot when it comes to obtaining licenses and insurance contracts. Below are some key items to know.

  • The order in which you obtain licenses and contracts is
    • State Board of Pharmacy,
    • then DEA,
    • you can get NPI and NCPDP once you have an address,
    • then insurance contracts.
  • CSOS (Controlled Substance Ordering System) can take 6 weeks
  • Your PSAO will obtain most of your insurance contracts other than Medicaid, Caremark, Humana, Express Scripts and Medicare Part B.
    • Caremark is a two step process with a pre-questionnaire and then an application.
    • Humana is also a two step process.
    • Express Scripts requires that you place an order and provide the invoice for your initial invoice in order to apply.
  • Optum is making new pharmacies wait 6 months from opening to receive contract.
  • Look out for Heat Zones which are Medicare excluded areas that can delay many contracts for up to one year.

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