Pharmacy Coverage

What drugs are covered by your plan?

Preventive medications

Under the Patient Protection and Affordable Care Act (PPACA), commonly called Affordable Care Act (ACA) or health care reform, some preventive medications may be covered at no cost (copay, coinsurance, or deductible) for Tufts Health Plan members, depending on their plan benefits.

Non-covered drugs with over-the-counter alternatives

Tufts Health Plan does not cover select prescription medications that you can buy without a prescription, or “over-the-counter.” These drugs are commonly referred to as OTC medications.

In addition, when OTC versions of a medication are available and can provide the same therapeutic benefits, Tufts Health Plan may no longer cover any of the prescription medications in the entire class. For example, non-sedating antihistamines are a class of drugs that give relief for allergy symptoms. Because many non-sedating antihistamines are available over-the-counter, Tufts Health Plan does not cover them.

Please refer to the pharmacy formulary for a list of covered medications. As always, we encourage you to speak with your provider about which medications may be right for you.