All states › PBM appeal channels
Where a MAC appeal actually goes
Mississippi's Board of Pharmacy keeps a roster of every PBM licensed in the state and the contact each one takes appeals at. It runs to sixty-odd names. Almost all of them route to one of about eight endpoints, because the plan you see on the claim is frequently not the company that processes the appeal.
That is good news. It means the list you have to know is short. Five of the eight take email, which also means you keep a timestamped record without doing anything extra — and in several states a PBM's failure to answer is itself a violation with a penalty attached, so the timestamp is the thing that matters.
CVS Caremark
Web portal onlyA single-claim form behind a CAPTCHA, with one account per store. If you file in volume this is the one that costs you real hours. Also handles CarelonRx, Scrip World.
Express Scripts
Portal, then a faxThe fax step is the problem. The portal alone does not complete the appeal, and it is easy to think you have filed when you have not. Also handles Express Scripts Inc, Alluma, Centene Pharmacy Services and 1 more.
OptumRx
Spreadsheet uploadThe easiest of the large PBMs to file with in volume, because the bulk upload is an official supported path rather than a workaround. Also handles Serve You Rx, Slate Rx (Optum-processed), Tmesys.
Prime Therapeutics
Email, fax, phone or mailEmail with an attachment, which means you keep a timestamped record without doing anything extra.
Humana
Email or faxEmail, so it is quick to file. Humana publishes less about what it wants than the others do.
MedImpact
Email or portalEasy to file. MedImpact publishes very little about required fields, deadlines or turnaround, so you are working from your state statute alone. Also handles Archimedes, AmWINS Rx, Fairview/Clearscript and 1 more.
Script Care
EmailA single mailbox behind eight plan names, which is why it is worth knowing about even though the name is unfamiliar. Also handles Alius Health, EmpiRx Health, Fairos Rx and 4 more.
RxSense
EmailAnother shared mailbox sitting behind several plan names. Also handles ProAct, True Rx, Verus Rx and 2 more.
What this list is not
It is not a claim about who pays fairly. It is where the paperwork goes and what each one says it needs. Whether they honour it is the open question, and the only way anyone finds out is if owners report back — which is what the tracker is for.
Compiled from each PBM's published appeal guide and the Mississippi Board of Pharmacy PBM appeals roster.