Pharmacy/Prescriptions

  • Meds

     

    Capital Rx manages our prescription benefits and Med-Pay is our third party administrator. 

     

     

     

     


Welcome to Capital Rx

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    RxContain  Specialty medications that are a part of this program are "carved out" of the pharmacy benefit and considered a benefit exclusion. Patient Assistant Programs provide full funding of certain medications to members that qualify. Please note that eligibility for this program is based on income. You will be asked to verify household income in order to qualify for the PAP program. The RxContain Care Advocate team is actively contacting members to assist with enrollment. You may also reach out directly to enroll at 844-922-7795.

    1. The RxContain team will attempt to enroll you in a patient assistance program (PAP).
    2. If successful, you will procure the drug via this program.
    3. If you are deemed ineligible for PAP, CapitalRx will work with you to secure a manufacturer copay assistance card, if available (RxCap). The RxCap program will run through the pharmacy benefit.

    RxContain list

    RxCap  Specialty medications that are part of this program are covered under the pharmacy benefit. A listing of covered drugs can be located in the RX FORMULARY. 

    1. When you have a prescription processed for one of these drugs, a message will be prompted at point-of-sale to notify the dispensing pharmacist that copay assistance is available. The pharmacist will then assist you in enrolling in the copay assistance program if they have not already.  You may also reach out directly to the Capital Rx Care Advocate team for assistance at 844-922-7795.
    2. The copay assistance funds available over a 12-month period will be used to reduce member cost share to $0 while also reducing cost share for the plan.
    3. After copay assistance funds are exhausted, member cost share will be changed to $0 and plan will pay 100% (typically this is only for 1-2 months, if at all, at the end of the year).

    RxCap list

     

Capital Rx App