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