Pharmacy Co-payments

We cover prescription medications for Tufts Health Together (MassHealth) and Tufts Health Direct (an individual and small-group plan) members.

Please see our medical benefit summary grids for more details about pharmacy co-payments, deductibles, and annual out-of-pocket maximum amounts.

There are no pharmacy co-payments, deductibles, or annual out-of-pocket maximums for Tufts Health Unify (Medicare-Medicaid One Care for people ages 21 – 64) members. For pharmacy information, see our Tufts Health Unify pharmacy program.

Please note:

  • Tufts Health Together members pay pharmacy co-payments of $3.65 for select covered generic and over-the-counter (OTC) drugs. Certain covered generic and OTC medications in the following drug classes have a $1 co-payment: antihyperglycemics, antihypertensives, and antihyperlipidemics.
  • When your Tufts Health Public Plans patients can get generic drugs, we will not cover the brand-name drug unless you request and receive prior authorization.
  • If we approve the brand-name drug, your patient will pay either a Tier 2 or Tier 3 co-payment:
    • Tier 2 — Tufts Health Together  
    • Tier 3 — Tufts Health Direct  

Products we cover with a prescription

Family-planning drugs and supplies
Together: No copayment | Direct: No copayment

Humidifiers and vaporizers
Together: No copayment | Direct: Not covered

Peak flow meters and spacers, for patients with asthma
Together: No copayment | Direct: 0%-20% coinsurance depending on plan level

Supplies for patients with diabetes
Together: No copayment | Direct: 0%-20% coinsurance depending on plan level

Tufts Health Plan patients who are exempt from pharmacy copayments

Patients younger than 21
Together: Exempt | Direct1: Not exempt 

American Indians and Alaskan Natives from federally recognized tribes
Together: Exempt | Direct1: Exempt

Women who are pregnant or whose pregnancy ended less than 60 days prior
Together: Exempt | Direct1: Exempt

Patients in nursing facilities, immediate-care facilities for the developmentally delayed, or hospitals serving patients with acute, chronic-disease, or rehabilitation needs
Together: Exempt | Direct1: Exempt

Patients in hospice care
Together: Exempt | Direct1: Exempt

Patients who have reached their pharmacy copayment cap for the calendar year
Together: Exempt | Direct1: Exempt

  1. Pharmacy exemptions apply only to Tufts Health Direct patients who qualify based on income.