Citi Benefits Handbook
Specialty Medication Copayment Assistance
PrudentRx Copay Program
You and your family will be eligible to participate in the PrudentRx Copay Program for certain specialty medications from drug manufacturers. PrudentRx reduces your cost share for eligible medications thereby reducing your out-of-pocket expenses. The PrudentRx Copay Program assists members by helping them enroll in manufacturer's copay assistance programs.
If you are not enrolled in the PrudentRx program, medications in the specialty tier will be subject to a 30% coinsurance on specialty medications that are eligible for the Prudent Rx program, and the amount may not count towards the deductible or out-of-pocket maximum. However, enrolled members who get a copay card for their specialty medication (if applicable) will have a $0 out-of-pocket coinsurance for their prescriptions covered under the PrudentRx Copay Program. Note, you must first satisfy the annual deductible under the High Deductible Health Plan with HSA.
If you currently take one or more medications included in the PrudentRx Program Drug List available at https://www.prudentrx.com/SpecialtyDrugList/ this list is subject to change), you will receive a welcome letter and phone call from PrudentRx that provides specific information about the program as it pertains to your medication, including how to enroll. If you take one or more eligible specialty medications, you must speak with a representative from PrudentRx to register for the specialty medication copay assistance program.
If you or a covered family member are not currently taking but will start a new medication covered under the PrudentRx Copay Program, you can reach out to PrudentRx directly or they will contact you the day after your applicable prescription is filled through CVS Specialty Pharmacy, so you can take full advantage of the PrudentRx program. PrudentRx can be reached at 1 (800) 578-4403 to address any questions regarding the PrudentRx Copay Program. The CVS Specialty pharmacy may also transfer you to PrudentRx when filling your prescription.
The amount that a participant is required to pay for certain specialty medications that are not subject to special treatment under the Affordable Care Act (not determined to be "essential health benefits" related to prescription drugs) will not count towards the Plan's out-of-pocket maximum, regardless of the payment source (the participant or the manufacturer copayment assistance program.
For questions about the PrudentRx Copay Program, please call 1 (800) 578-4403.