TRS ActiveCare Touts “FREE” Specialty Drug Benefit

Feel-good email brings great news for plan members but threatens plan finances…..

The following is part of a feel-good email sent by TRS to all TRS ActiveCare school districts yesterday (THE BOLD ITALIZED ARE OUR COMMENTS ):

With the new PrudentRx specialty drug assistance program, specific prescriptions are at no cost, (PERTAINS TO MEMBER ONLY, PLAN DOES NOT SAVE A DIME) potentially saving you (MEMBER ONLY) tens of thousands of dollars, or more!

Many health plans either don’t have specialty medicine coverage or their coverage is so limited it could bankrupt you. (NOT NECESSARILY TRUE. MOST PLANS ELIMINATING SPECIALTY DRUGS HAVE A BACKUP STRATEGY)

Copay assistance is a process in which drug manufacturers provide financial support to patients (NOT PLANS) by covering all or most of the patient cost share for select medications, in particular specialty medications. The PrudentRx Copay Program will help plan members get copay assistance from drug manufacturers to reduce a member’s cost share for eligible medications thereby OOP expenses.

Q1: What is PrudentRx Copay Program?

The PrudentRx Copay program combines an innovative specialty copay plan design strategy and improved member experienceto help optimize savings from non-needs based manufacturer copay cards and reduce member costs. (DOES NOT IMPROVE PLAN’S CLAIM EXPERIENCE) The program allows members to pay $0 OOP for all specialty medications on the plan’s Exclusive Specialty drug list dispensed by CVS Specialty, regardless if a copay card is available. (DOES NOT BENEFIT PLAN SPONSOR WHO’S PAYING ALL OF THIS)

Q2: What is a manufacturer sponsored copay card? (A DEVICE TO ENCOURAGE HIGHER DRUG COST USAGE) A third-party-sponsored copay card is a direct-to-consumer incentive manufacturers offer to promote brand loyalty (ENCOURAGES USE OF HIGH COST DRUGS WHEN THERE MAY BE A CHEAPER ALTERNATIVE) and the use of brand-name pharmaceutical products. The copay card can also be used to lower OOP costs for eligible patients