Pharmacy Copayments

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

See the medical benefit summary grids for more details about pharmacy copayments, deductibles and annual out-of-pocket maximum amounts.

*Note: There are no pharmacy copayments, deductibles or annual out-of-pocket maximums for Tufts Health RITogether or Tufts Health Unify. :

  • Tufts Health Together members pay pharmacy copayments of $3.65 for select covered generic, preferred brand name and over-the-counter (OTC) drugs. Certain covered generic and OTC medications in the following drug classes have a $1 copayment: antihyperglycemics, antihypertensives and antihyperlipidemics.
  • When generic drugs are available, Tufts Health Plan will not cover the brand-name drug unless you request and receive prior authorization.
  • If Tufts Health Plan approves the brand-name drug, patients will pay either a Tier 2 or Tier 3 copayment:

    *Some members with extended family planning benefits may have a small prescription copayment. This is a fixed amount members have to pay for a covered service.

    Products Covered 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: Tier 2

    Blood glucose meters and test strips for patients with diabetes
    Together: No copayment | Direct: Up to a Tier 2 cost share for preferred products

    Pharmacy Copayments Exemptions — Tufts Health Together

  • Patients younger than 21
  • American Indians and Alaskan Natives from federally recognized tribes
  • Women who are pregnant or whose pregnancy ended less than 60 days prior
  • Patients in nursing facilities, immediate-care facilities for the developmentally delayed, or hospitals serving patients with acute, chronic-disease, or rehabilitation needs
  • Patients in hospice care
  • Patients who have reached their pharmacy copayment cap for the calendar year