Pharmacy Copayments

Do you have a copayment?

Most members ages 21 and older will have to pay a small copayment for covered prescription drugs. Find out if you will have to pay a copayment.

How much is the copayment?

Copayment amounts for first-time prescriptions and refills are:

  • $3.65* for brand-name prescription drugs, called “Tier 2 medications”
  • $1 to $3.65* for generic prescription drugs (nonbrand name) and covered over-the-counter drugs (such as cough medicine, pain relievers and allergy drugs), called “Tier 1 medications”

Members have a copayment cap (limit) of $250 on the copayments pharmacies can charge each calendar year (January 1 – December 31). The cap is the total amount of copayments pharmacies have charged you, not what you paid.
*Pharmacy copayments for covered generic, preferred brand-name and select over-the-counter drugs are $3.65. Generic drugs for diabetes, high blood pressure, and high cholesterol have a $1 copayment.

What if you do not have money for the copayment?

If at any time you cannot pay a copayment, the pharmacist must still fill your prescription. The pharmacy may bill you later for any unpaid copayments.

What does not require a copayment?

With a doctor’s prescription, you do NOT have to pay a copayment for:

  • Family-planning drugs and supplies, such as birth control pills
  • Humidifiers and vaporizers
  • Diabetic supplies
  • Spacers and peak flow meters for asthma

Questions?

If you have any questions about copayments or pharmacy bills, please call us at 888.257.1985  (TTY: 711), Monday through Friday, 8 a.m. to 5 p.m. We're happy to help.