Yearly Copayment Limit
Unless you do not need to pay a copayment, MassHealth members ages 21 and older have a $250 copayment cap (limit) on the copayments pharmacists can charge each calendar year (January 1 – December 31). The cap is the total amount of copayments pharmacists have charged you, not what you have paid.* A pharmacy should never charge you a copayment after you reach the cap, even if you have not paid all the charges up to $250.
Reached your copayment cap?
If your pharmacy continues to charge you a copayment, tell the pharmacist you met the copayment cap. If you have any problems, call us at 888.257.1985 (TTY: 711), Monday through Friday, 8 a.m. to 5 p.m. We're happy to help.
*Pharmacists must still fill your prescription even if you cannot pay your co-payment.