Answers to Common Questions
INSURED MEMBERS ENROLLED THROUGH AN EMPLOYER
INSURED MEMBERS ENROLLED INDIVIDUALLY
What pharmacies can I go to?
Our networks cover 100% of chain pharmacies and 90% of independents. If your pharmacy says they aren’t contracted, the process to add them is quick and easy! Simply contact us using the chat feature on our website and we will assist in getting that process started.
To find network contracted pharmacies in your area, please navigate to the Resources drop down in the top menu bar and click on Pharmacy Locator.
What should I do if I am prescribed a Specialty Medication?
Specialty medications are typically defined as expensive drugs used to treat chronic, rare, or complex conditions. They often meet the following criteria:
Administration: They can be given by infusion (intravenously), injection, or taken orally.
Special Handling: Some specialty medications have unique storage and handling requirements.
Strict Schedule: They may require adherence to a very specific dosing schedule.
High Cost: Specialty drugs can cost more than traditional medications, often exceeding $1,000 per 30-day supply. For instance, the Medicare Part D program considers a drug to be specialty if it costs more than $600 per month. The average annual cost of a specialty drug is around $53,000. Keep in mind that these figures can vary based on specific medications.
WHAT TO DO IF YOU ARE PRESCRIBED A SPECIALTY MEDICATION:
Contact PRAM right away. PRAM’s RxBoost program is designed for just this scenario. RxBoost is a NON-INSURED membership program helps participants
navigate the complex and expensive world of specialty drugs. Patient Representatives will pair participants with the best possible program to bring
down the cost of their expensive medications by providing access to co-pay assistance programs, international sourcing, and charitable foundations.
Patient Assistance Programs (PAPs) are also available if the participant
qualifies. For more information or to enroll, click HERE.
What if my medication is not covered?
If a medication is not on the formulary, the program participant is still eligible to purchase that drug at the contracted Pharmacy Benefit Manager’s (PBM’s) discounted rate.
What if the Pharmacist can’t locate my eligibility?
Ask the pharmacist to verify that they are entering your person code “01” (02
for a spouse, 03 for child #1, and so on) after your member number. Many
pharmacists mistakenly leave this off, however it is part of your Member
ID and must be included. If they are entering it correctly or there are other
issues, a quick call to the pharmacist / member services number on your ID card should resolve any problems quickly.
Are these programs qualified under Medicare Part D?
None of PRAM’s programs are qualified plans under Medicare Part D. Consult with a Medicare specialist prior to enrolling if you are over the age of 64.
What is the best way to get a hold of a PRAM specialist?
PRAM is open Monday – Friday 8:30am – 4:30pm in the Pacific Time Zone. The best way to reach us is through the chat feature located in the bottom right corner of each page on our website. We do our best to be available anytime, not just during business hours, though we may take a little longer to respond if it is outside of those hours. We strive to provide the best customer service possible!
