Specialty Meds Made Accessible and Affordable with PrudentRx

December 8, 2023

Image of a man receiving prescription meds from a pharmacy

Prescription drug prices are on the rise, and this upward trend shows no signs of slowing down. More than one in four adults taking prescription drugs report difficulty affording their medication, according to a KFF poll from July 2023.

At Gravie, we know that medication adherence directly impacts health outcomes and drives overall healthcare costs down in the long run. Consequently, no one should be forced to delay or not take a medically necessary prescription because they can’t afford it or have it shipped to their door.

Specialty medications that treat complex or chronic conditions are especially subject to high out-of-pocket costs, and represent 50% of total prescription drug spending in the U.S. This class of drugs is one of the fastest-growing and most expensive areas in the pharmacy industry. It’s a financial barrier that can prevent individuals from accessing the necessary medications needed to treat an acute illness, or to simply live everyday life normally.

People who require specialty medications often face complex care needs and face higher healthcare costs in general. Comfort®’s extensive list of no-cost services has members covered, including everything from in-network specialist appointments to urgent care visits, as well as generic meds and many preventive drugs. But for someone on a traditional plan requiring one of these specialty medications, it’s likely a different story — they’re already dealing with ongoing charges and copays from doctor’s visits, labs and other medically necessary prescriptions that can add up quickly even before specialty medications are added to the equation. Just another way that Comfort shines in comparison.

Easing the cost-share burden on specialty medications

With Comfort, members can rest assured that all generic prescriptions are completely covered. And now, those taking many of the most frequently prescribed specialty medications will reap the same benefit.

In 2024, Gravie will offer a new specialty medication savings program for members through our pharmacy administrator CVS Caremark. PrudentRx is an exclusive program offered through CVS Specialty that helps members access specialty medications at a more affordable price –$0 for all meds that qualify – through copay assistance from drug manufacturers.

Members filling specialty medications will be prompted to enroll in PrudentRx automatically, and will receive a welcome letter and phone call from PrudentRx providing personalized information about the program as it pertains to each of their medication(s) and individual needs. CVS Caremark’s easy-to-use mobile app is also available to manage specialty prescriptions and effortlessly coordinate delivery or pickup at a convenient CVS retail pharmacy.

When our members stay healthy, everyone wins

The choice to forgo a specialty medication could be life-threatening for many people. For example, someone with a hepatitis B infection could end up with liver damage or liver cancer if they don’t treat it early on with the necessary specialty antiviral medication.

Pulmonary hypertension, another serious condition, is typically treated with continuous IV infusions. A small pump is commonly used to infuse these medications and must be carried on the patient at all times. If someone forgoes getting an extra pump from the specialty pharmacy because the cost is too high, or there’s a delay with shipping, it could be life threatening in the case of an emergency.

Health benefits should address the comprehensive wellbeing of members, offering a range of care options and implementing measures to make that care more affordable whenever possible.

For us at Gravie, investing more in pharmacy coverage upfront means it’s easier for individuals and their families to take their necessary medications exactly as prescribed and to prioritize their overall health. By promoting medication adherence in this way, we help individuals reduce their risk of additional health complications in the long run.

Just another way Gravie is working to remove barriers so members can access the best healthcare possible.

Want to learn more about our partnership with CVS Caremark or PrudentRx?  Get in touch.

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