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?

A copay is a small amount that a member pays when they get health services. The only time that a member may have a copay is when they get certain prescription drugs. Most members pay the following pharmacy copays:

  • $1 for each prescription and refill for each generic drug and over-the-counter drug covered by MassHealth in the following drug classes: antihyperglycemics, antihypertensives, and antihyperlipidemics; and
  • $3.65 for each prescription and refill for all other generic, brand-name, and over-the-counter drugs covered by MassHealth that are not $1 as outlined above or excluded

If a member is receiving a 90-day supply of a MassHealth covered prescription drug, the total copay amount for that 90-day supply will still either be $1 or $3.65 as outlined above.

Members who CANNOT pay the copay

The pharmacy cannot refuse to give members their covered drugs even if they cannot pay the copay. However, the pharmacy can bill members later for the copay. Members must call the Tufts Health Plan Member Services at 888-257-1985 (TTY: 711) if a pharmacy does not give them the drugs.

The following prescriptions and refills do NOT have any pharmacy copays:

  • Drugs used for substance use disorder (SUD) treatment, such as medication-assisted therapy (MAT) (for example, Suboxone or Vivitrol),
  • Certain preventive drugs such as low-dose aspirin for heart conditions, drugs used to prevent HIV, and drugs used to prepare for a colonoscopy,
  • Certain vaccines and their administration,
  • Family planning drugs or supplies, such as birth control pills (oral contraceptives),
  • Drugs to help you stop smoking,
  • Emergency services,
  • Provider preventable services, or
  • Other services described in MassHealth regulations (130 CMR 506.015 and 130 CMR 520.037).

Prescription drugs are the only benefit that may have copays. There are no copays for other covered services and benefits.

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.