PrudentRX Copay Program
PrudentRx for specialty medications is included in the CMU Prescription Drug benefit. This program lowers your out-of-pocket costs by assisting you with enrollment in drug manufacturers' discount copay cards / assistance programs. When enrolled in PrudentRx, your out-of-pocket cost will be $0* for medications included on the PrudentRx specialty drug list [pdf].**
If you opt out of the PrudentRx program, you will be responsible for the 30% coinsurance.
- PPO/HMO/EPO participants who opt out: Only the amount you pay out of pocket will apply toward your out-of-pocket maximums for essential health benefit medications.
- HD PPO w/HSA participants who opt out: Only the amount you pay out of pocket will apply toward your deductible/out-of-pocket maximums.
*HD PPO w/HSA participants must meet their combined medical/prescription deductible before the out-of-pocket cost will be $0.
** If a participant’s specialty medication is not on the PrudentRx list, then the Specialty plan design will apply.
How to Enroll
- Verify that your medication is eligible under the program by checking the list of eligible drugs [pdf].
- Contact PrudentRX at 800-578-4403 to enroll each eligible medication you are taking.
- PrudentRX will enroll you in the program, and the cost to fill your medication will be $0.
- There is no downside or risk to signing up for PrudentRX, so it is best to go through the program for eligible medications.
- Participants in the High Deductible PPO with HSA plan will need to meet their deductible before the PrudentRX Specialty Drug Copay Program will apply.
- For complex cases, talk to PrudentRX before your first fill or dose.
- Some manufacturers require you to use their cost assistance program before using a copay discount program. PrudentRX will apply as usual after the manufacturer discount runs out.
- Some medications require your first dose to be administered in a medical facility, and that dose can be covered through the Medical or Prescription plan. In order for the PrudentRX discount to apply, the claim must be run through the Prescription plan.