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Specialty Medication Cost Calculations (Base and Select Plans)
Effective 2026, manufacturer copay assistance programs (“copay cards”) for specialty medications will no longer count toward your annual deductible or out‑of‑pocket (OOP) maximum. Only the amount you actually pay will apply toward your calendar‑year deductible (CYD) and OOP maximum. You may continue using copay cards; however, any dollars you receive from the manufacturer will no longer count towards your deductible or OOP maximums.
Introduction of PrudentRx for the Select Plan
Effective 2026, the Select Plan will add an optional program called PrudentRx for specialty medications included on the PrudentRx drug list. Participants who enroll in PrudentRx will pay $0 out‑of‑pocket for eligible specialty medications by maximizing available manufacturer assistance (coupons, copay cards, etc.).
- If you do not enroll, a 30% coinsurance will apply to specialty medications.
- Third‑party assistance used through PrudentRx will not count toward your CYD or annual OOP maximum.
Eligible participants will receive additional details and instructions on how to enroll.