78 Copayments for these medications, whether made by you, your plan, or a manufacturer’s copay assistance program, will not count toward your plan deductible. Because certain specialty medications do not qualify as “essential health benefits” under the Affordable Care Act, member cost share payments for these medications, whether made by you or a manufacturer copayment assistance program, do not count towards the Plan’s out-of-pocket maximum. A list of specialty medications that are not considered to be “essential health benefits” is available. An exception process is available for determining whether a medication that is not an essential health benefit is Medically Necessary for a particular individual. Enrollment If you currently take one or more medications included in the PrudentRx Copay Program Drug List, you will receive a welcome letter and phone call from PrudentRx that provides specific information about the program as it pertains to your medication. All eligible participants are enrolled in the PrudentRx Copay Program via an easy two-step process: 1) The first step of enrollment is already complete as your member information is on file with PrudentRx; 2) You need to call PrudentRx at 1-800-578-4403 within five (5) days of receipt of the letter to register for any copay assistance available from drug manufacturers. Some manufacturers require you to sign up to take advantage of the copay assistance that they provide for their medications — in that case, you must speak to someone at PrudentRx at 1-800- 578-4403 to provide any additional information needed to enroll in the copay program. PrudentRx will also contact you if you are required to enroll in the copay assistance for any medication that you take. If you do not return their call, choose to opt out of the program, or if you do not affirmatively enroll in any copay assistance as required by a manufacturer you will be responsible for the full amount of the 30% co- insurance on specialty medications that are eligible for the PrudentRx program. Opting Out of the PrudentRx Copay Program You can choose to opt out of the PrudentRx Copay Program, by calling 1-800-578-4403. As noted above, if you opt out, you will be responsible for the 30% co-insurance on specialty medications. PrudentRx Contact PrudentRx can be reached at 1-800-578-4403 to address any questions regarding the PrudentRx Copay Program. Virta Responsible Prescriber Program National IAM Benefit Trust Fund has partnered with Virta Health, a virtual clinic specializing in sustainable weight loss and diabetes care for those 18 years or older. In partnership with CVS Health, the Fund is enhancing support for member’s health goals. This program involves new clinical requirements for coverage of certain medications, specifically GLP-1 medications for weight loss. Through Virta, members will have access to a dedicated care team, digital health tools, and personalized support all at no cost to the member.