New Prescription Drug Benefits Available September 1, 2021

A sneak peek at three new programs coming to your prescription drug benefits under CVS Caremark.

The transition to CVS Caremark will bring three new programs that promise to enhance your prescription drug benefits through additional savings and care management support. The programs described below will be available to covered Health Plan participants under the prescription drug benefit on September 1, 2021. Additional details about these programs will be available in the Summer 2021 issue of the Spotlight on Benefits newsletter.

PrudentRx: $0 out-of-pocket cost for specialty medications

The PrudentRx program will decrease the out-of-pocket cost of your specialty medications to $0 through co-payment assistance. PrudentRx works with drug manufacturers on your behalf to enroll you in manufacturers’ co-payment assistance programs if such programs are available for your medications. Additionally, for as long as you are enrolled in the program, PrudentRx will manage your renewals for those co-payment assistance programs. Where such a program is not available or when your eligibility for a manufacturer’s assistance program has been exhausted, the out-of-pocket costs for your specialty medications filled through CVS Specialty will remain at $0 for as long as you remain in the PrudentRx program.

PrudentRx works closely with CVS Specialty to ensure all applicable savings are applied to your specialty medications before they are delivered. Specialty prescriptions filled at any pharmacy other than CVS Specialty will not be eligible for PrudentRx savings, and you will be responsible for the applicable co-payment and/or co-insurance.

AccordantCare Rare: Multi-disciplinary support for complex needs

Participants with rare conditions are proven to benefit from a multi-disciplinary approach to their complex needs. The AccordantCare Rare program provides such support for participants with any of 19 rare or chronic conditions by pairing participants with a case management nurse with deep knowledge of their specific conditions. Through an ongoing relationship with the primary nurse in consultation with the participant’s providers and caregivers, additional experts will be brought in as needed to support the participant’s care. These experts might include resource specialists to support the participant’s transportation, respite care or financial assistance needs and medical directors/advisory boards to provide specialized consultations for complex needs.

AccordantCare Rare enrollees and their caregivers are provided 24/7 telephone access to specialized nurses with whom they can discuss any aspect of their health and wellness, including symptoms they might be experiencing, services they might need or help with navigating the health care system and benefits. Additionally, the dedicated AccordantCare Rare nurse will reach out on at least a quarterly basis to monitor the enrollee’s needs.

Health Advisor: Individualized support that changes with your needs

Managing a chronic condition can be a challenge, especially over time as your life changes. Health Advisor supports you through those changes by making sure you stay on track with all aspects of your healthcare. Health Advisor takes into account your ongoing circumstances to keep you informed of the next best actions you should take, not only in regards to your chronic condition, but for your continued overall health and wellness. Depending on your circumstances, Health Advisor may send you messages—via telephone, direct mail, email, SMS text, prescription bag messages, messages through your provider and/or face-to-face pharmacist consultations—with recommended actions you might take to maintain your health or manage your chronic condition. You and your doctor can then decide what actions, if any, to take.