If you or a covered family member take one or more specialty medications included in the PrudentRx drug list, you will receive a welcome letter from PrudentRx on behalf of the plan that provides information about the PrudentRx program as it pertains to your medication(s). All eligible members’ enrollment will begin automatically in the PrudentRx program, but there may be additional steps required.
PrudentRx will also contact members if they are required to enroll in the copay assistance for any medication that they take. PrudentRx continuously monitors copay card utilization and will conduct proactive member outreach as needed, including re-enrollment in available assistance programs.
When a new prescription is received and processed by the pharmacy, there is an administrative process to capture the claim and perform outreach to the member. From there, the pharmacy will offer to transfer the member to PrudentRx or will provide the member with the PrudentRx contact information to complete any necessary steps for enrollment. Prior authorization (PA) and formulary are not affected by the PrudentRx program.
A trained PrudentRx member advocate will help the member enroll in the available manufacturer copay assistance program where applicable. This process usually takes less than ten minutes but may take up to five to seven days depending on the manufacturer process. The member will be informed throughout the process.