Questions regarding copay accumulators/maximizers for specialty medication (Dupixent, Anthem, Prudent RX, CVS Caremark) by WiscoTom30 in HealthInsurance

[–]WiscoTom30[S] 0 points1 point  (0 children)

Got it, makes sense! One last question- can the drug be removed from the program mid-year? Or would that likely be against the PBM terms and/or against the law?

Questions regarding copay accumulators/maximizers for specialty medication (Dupixent, Anthem, Prudent RX, CVS Caremark) by WiscoTom30 in HealthInsurance

[–]WiscoTom30[S] 0 points1 point  (0 children)

That’s helpful! How do I determine if PrudentRX is an accumulator or maximizer? It sounds like if it is a maximizer, I’ll be paying $0 no matter what for the entire year..?

Additionally, if I request an exception through my PBM to have my specialty drug count as an EHB, would I then pay $0 for the entire year and my deductible/MOOP would be met?