PrudentRx Copay Program FAQs

To provide a comprehensive and cost-effective prescription drug program for you and your family, the National IAM Benefit Trust Fund has partnered with PrudentRx to offer the PrudentRx Copay Program for certain specialty medications.

PrudentRx will work with you and the drug manufacturer to provide copay card assistance when available as well as guide you through the copay card renewal process when necessary. Even if your specialty medication has no copay card, your out-of-pocket cost will be $0 if you are enrolled in the PrudentRx Copay Program.

PrudentRx is integrated with CVS Specialty Pharmacy Operations, as a third-party, to ensure a seamless premium member experience. The National IAM Benefit Trust Fund partnership with PrudentRx makes it possible to receive your covered specialty medications at $0 out of pocket cost when you fill your prescription at a CVS Specialty Pharmacy or other participating specialty pharmacies.

For additional information about the PrudentRx Copay Program, please contact PrudentRx directly at 1 (800) 578-4403, Monday through Friday between 8 a.m. and 8 p.m., EST.

There are hundreds of specialty medications available today and that number is rapidly growing. Rare diseases requiring specialty medication affect millions of patients. Many patients are suffering, but few and limited treatment options are available. Specialty medications typically cost several hundred dollars monthly as they may require unique methods of administration such as injections, infusions, or nebulizers. In addition, routine patient monitoring may require lab tests, office visits, enrollment and documentation into monitoring programs, medication risk evaluation and prior authorization by insurers.

Specialty pharmacies, like CVS Specialty, help the patient simplify the sometimes-complex process of accessing and utilizing specialty medications. Specialty pharmacies assist with insurance paperwork and reimbursement services for potentially life-saving specialty medications. Importantly, they coordinate insurance benefits to help patients reduce their out-of-pocket costs. One of the most important services a specialty pharmacy can provide is patient care services to support patients who are facing insurance coverage and affordability reimbursement challenges.

Copay assistance is a process in which drug manufacturers provide financial support to patients by covering all or most of the patient cost share for select medications - in particular, specialty medications.

PrudentRx will work with you and the drug manufacturer to provide copay assistance when available as well as guide you through the copay card renewal process when necessary. Even if your specialty medication has no copay card, your out-of-pocket cost will be $0 if you are enrolled in the PrudentRx Copay Program.

If you currently take one or more medications included on the PrudentRx Program Drug List, you will be automatically enrolled in the PrudentRx Copay Program.   All eligible members will receive a welcome letter and phone call from PrudentRx that provides specific information about the Program as it pertains to your medication.

Some drug manufacturers require you to enroll to take advantage of the copay assistance that they provide for their medications.  In that case, you must speak to a PrudentRx Member Advocate to grant them permission to enroll you in the drug manufacturers’ copay assistance program.  PrudentRx will contact you directly if you are required to enroll in the copay assistance program for any specialty medication that you take.

If you or a covered family member are not currently taking but will start a new medication covered under the PrudentRx Copay Program, you should contact PrudentRx immediately to take full advantage of the Program. PrudentRx may also contact you directly if you are required to enroll in the copay assistance program for any medication that you plan to start taking.

For additional information about the PrudentRx Copay Program, please contact PrudentRx directly at 1 (800) 578-4403, Monday through Friday between 8 a.m. and 8 p.m., EST.

Yes, eligible dependents may be covered by the PrudentRx Copay Program.

To determine if a family member or dependent is covered by the PrudentRx Copay Program, please contact PrudentRx directly at 1 (800) 578-4403, Monday through Friday between 8 a.m. and 8 p.m., EST.

You have the right to opt out of the PrudentRx Copay Program.  If you choose to opt-out of the program, or if you do not affirmatively enroll in any copay assistance as required by a drug manufacturer, you will be responsible for the full amount of the 30% co-insurance on specialty medications that are eligible for the PrudentRx Copay Program.

If you choose to opt out of the PrudentRx Copay Program, you may re-enroll at a later date by contacting PrudentRx; however, only those prescriptions filled after you have enrolled in the PrudentRx Copay Program will be at a $0 cost.

If you are already enrolled in a drug manufacturer copay assistance program, you should contact PrudentRx immediately to provide a Member Advocate with that information and to ensure that your out-of-pocket responsibility is $0 even if copay assistance funds are exhausted.

Copayments for specialty medications covered by the PrudentRx Copay Program, whether made by you, your plan, or a manufacturer’s copay assistance program, will not count toward your plan deductible.

The specialty medications covered by the PrudentRx Copay Program are included in PrudentRx Program Drug List.  The PrudentRx Program Drug List is updated periodically.

For additional information about the PrudentRx Program Drug List, please contact PrudentRx directly at 1 (800) 578-4403, Monday through Friday between 8 a.m. and 8 p.m., EST.

For additional information about the PrudentRx Copay Program, please contact PrudentRx directly at 1 (800) 578-4403, Monday through Friday between 8 a.m. and 8 p.m., EST. (English, Spanish, and other language lines available).