With the Prudent Rx program from EHP, members can receive specialty medication on the PrudentRx Specialty Drug List for $0 instead of a 30% co-insurance.
How it works
Members are eligible for the Prudent Rx program if they take one or more of the medications on the PrudentRx Specialty Drug List. A Prudent Rx trained member advocate will guide you through the program enrollment process, and obtaining manufacturer copay card assistance, when available. When unavailable, members who enroll in the Prudent Rx program will still pay $0 for covered medications.
Prudent Rx’s member advocates will continue to assist members with program re-enrollment and assistance renewals.
Please note: Some manufacturers require members to sign up to utilize the copay assistance that they provide for their medications – in that case, members must speak to someone at PrudentRx to provide any additional information needed to enroll in the copay program. Participation in the program requires certain data to be shared with the administrators of these copay assistance programs, but please be assured that this is done in compliance with The Health Insurance Portability and Accountability Act of 1996 (HIPAA).
How to enroll
If you currently take one or more of the medications included on the PrudentRx drug list, you will receive a welcome letter and phone call from PrudentRx that provides information about the program as it pertains to your medication(s). All eligible members’ enrollment will begin automatically in the PrudentRx program, but you can choose to opt out of the program by calling 800-578-4403. If you choose to opt out of the program, or do not affirmatively enroll in available copay assistance as required by a manufacturer, you will be responsible for the full 30% co-insurance on specialty medications under your plan design after satisfying any applicable plan deductible.
If you or a covered family member are not currently taking but will start a new medication covered under the PrudentRx program, you can reach out to PrudentRx or they will proactively contact you to assist with program enrollment.
Prudent Rx FAQs
What is the PrudentRx program?
The PrudentRx program combines an innovative specialty plan design strategy and best-in-class member experience to help lower spend and with members enjoying reduced costs. The program applies to all specialty medications in a Covered Class on the PrudentRx program drug list and allows members who are participating in the program to pay $0 out of pocket (OOP) for specialty medications, regardless if a copay card is available.
What is a third-party sponsored copay card or manufacturer copay card assistance program?
A third-party sponsored copay card, or manufacturer copay card assistance program, is a direct-to-consumer incentive manufacturers offer to promote brand loyalty and the use of brand-name pharmaceutical products. The copay card can also be used to lower OOP costs for eligible patients.
Are there different types of copay card assistance programs?
Yes. There are two types of copay card programs offered:
- Non-Need Based: This type is offered to commercially insured populations. These copay cards may be used regardless of a patient’s financial status and do not require any form of eligibility or qualification to get assistance.
- Need-Based/Patient Assistance Program (PAP): This type is offered by a manufacturer sponsor or independent non-profit to help patients who meet specific financial eligibility criteria. These patients may be uninsured, underinsured or may have been denied coverage by commercial plans. This type of assistance is not part of the PrudentRx program, but your specialty pharmacy may be able to help you, if needed, in connecting with these types of programs.
What happens if I am already enrolled in a manufacturer copay card assistance program?
You will continue to fill prescriptions as usual. The integration between the pharmacy and PrudentRx will ensure the copay assistance is applied toward the member cost share by the pharmacy and that the pharmacy has visibility into your PrudentRx program enrollment status.
What if my medication requires a PA?
You need to go through the usual PA and appeals process before the medication is processed by the pharmacy. While your PA is being reviewed, you can still confirm enrollment or opt out of the PrudentRx program. If your medication is not approved, your doctor may be able to prescribe a different medication for you.
Need help?
If you have any questions about the PrudentRx Program, call them at: