What is a manufacturers coupon? A manufacturers coupon (also known as a copay card, copay coupon, copay assistance card, or manufacturer financial assistance) is part of the copay savings programs offered by manufacturers of medication to members with commercial health insurance. How do I enroll myself or my dependent in the program? If you or your dependent is taking an eligible medication, and youre not using a coupon to cover your costs, a Care Team Coordinator from PillarRx will call to talk to you about the program and walk you through the enrollment process. Theyll also call you if you or your dependent start taking a new eligible medication. You can also call PillarRx directly at 1-636-614-3128 (TTY: 711 ). Do I need to enroll if Im already using a manufacturers coupon for an eligible medication? No. If youre already using a manufacturers coupon, youll be automatically enrolled in the program . A Care Team Coordinator from PillarRx will call you to confirm your participation. Theyll also ensure that youre paying the lowest possible cost for your medication. You can also call PillarRx directly at 1-636-614-3128 (TTY: 711 ). Am I required to be enrolled in the program? No, enrollment is optional. However, if you dont enroll yourself or your dependent in the program, or decide to opt out after being enrolled, your out-of-pocket costs for your medications will be higher because youll be responsible for paying 30% of the cost of the eligible medications. What if I filled my eligible medication before I enrolled in the program? If youve already filled an eligible medication and youre eligible for the program, call PillarRx at 1-636-614-3128 (TTY: 711 ) to learn more about retroactive enrollment. How does the program affect my out-of-pocket maximum? Once you or your dependent is enrolled in the Cost-Share Assistance Program, your plan will apply only your actual out-of-pocket costs to your annual out-of-pocket maximum. For example, if you pay $10 for an eligible medication, only $10 will be applied to your annual out-of-pocket maximum. How does the program affect my deductible? If you have a Health Savings Account (HSA)-qualified Saver plan, or a plan with a deductible that applies to your pharmacy benefits, your plan will apply your out-of-pocket costs to your annual deductible as well as to your out-of-pocket maximum. 1 For example, if you pay $10 for an eligible medication, only $10 will be applied to both your out-of-pocket maximum and your deductible. What happens if the manufacturer no longer offers financial assistance for my medication? PillarRx will notify you that your medication is no longer eligible for this program. Youll then pay the standard cost share for this medication according to your pharmacy benefit. Check your Summary of Benefits or Schedule of Benefits for details. Are there instances where I may not be able to sign up for the program? Although most members can enroll, there may be specific instances that make you ineligible for the program, such as: You have or are eligible for government health insurance, such as Medicare or Medicaid. Your medication isnt approved by the Food and Drug Administration (FDA) to treat your condition. Your medication has specific age restrictions you dont meet. You use a secondary insurer in addition to Blue Cross to cover your plans out-of-pocket costs. If a manufacturer of medication determines that youre ineligible for the program, PillarRxs Care Team will ensure that your medication is covered, based on the standard cost-share amount that applies for all other covered medications and supplies as described in your Summary of Benefits, Schedule of Benefits, and/or riders. In this instance, you wouldnt be eligible for cost savings for your medication through this program. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. Registered Marks of the Blue Cross and Blue Shield Association. Registered Marks are the property of their respective owners. 2024 Blue Cross and Blue Shield of Massachusetts, Inc., or Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. 002745206 55-001544994 (5/24) Blue Cross Blue Shield of Massachusetts complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, or gender identity. ATTENTION: If you dont speak English, language assistance services, free of charge, are available to you. Call Member Service at the number on your ID card (TTY: 711 ). ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia con el idioma. Llame al nmero de Servicio al Cliente que figura en su tarjeta de identificacin (TTY: 711 ). ATENO: Se fala portugus, so-lhe disponibilizados gratuitamente servios de assistncia de idiomas. Telefone para os Servios aos Membros, atravs do nmero no seu carto ID (TTY: 711 ). 1. Exceptions may apply. Check your plan materials for details. See if your medication is eligible To see a list of eligible medications: 1 . Download the MyBlue app, or create an account at bluecrossma.org . 2 . Once signed in, click Cost-Share Assistance under My Medications . 3 . Select See Eligible Medications . You can also call PillarRx Care at 1-636-614-3128 (TTY: 711 ), Monday through Friday, 8:00 a.m. to 7:00 p.m. ET.