Thank you for applying to the Prism Spectra program.
Thank you for applying to the Prism Spectra program. This program is geared towards healthy individuals who are taking very little or no medications. The medications you are taking will more than likely be excluded under these particular programs. If you are unsure if your medication(s) will be covered, please give us a call. This program is an underwritten program, which means your eligibility is based on your current medical condition and the prescription(s) you may be taking. Please make sure you fill out all information boxes and read and check all checkboxes in order to apply successfully.
Providing marketing and administration for
Prism® Health and Dental Programs
Coverage provided by
First name of person
Name of drug
Length of time using the drug
Number of refills per year
Date of last refill
Approx. monthly cost