PrudentRx

GW's PPO and HSP prescription benefit includes PrudentRx for specialty medications.

This program is designed to lower your out-of-pocket costs by facilitating enrollment in drug manufacturers discount co-pay cards/assistance programs. When enrolled in PrudentRx, your out-of-pocket cost will be $0 for medications included on the PrudentRx exclusive specialty drug list, which is updated monthly.

*HSP participants must meet their combined medical/prescription deductible before the out of pocket cost will be $0.

Formulary exclusions will supersede this list. If a participant’s specialty medication is not on the PrudentRx list, then the brand formulary or brand non-formulary plan design will apply.

How to Enroll in PrudentRx

Members must enroll in the PrudentRx program to access $0 copay benefits. Participants will be contacted via phone by CVS to enroll in PrudentRx at the time of your first specialty fill. You must complete any additional enrollment steps outlined by CVS to receive the $0 benefit. 

Please note: If a member opts-out, they will be responsible for the 30% coinsurance. The amount a member pays out of pocket for essential health benefit medications will apply toward their deductible and out of pocket maximums; however, the amount members pay for non-essential health benefit medications will only apply toward their deductible, it will not apply toward their out-of-pocket maximum.