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

Service

Together

Direct

Family-planning drugs and supplies

Check Blue 15 No co-payment check red 15 No co-payment

Humidifiers and vaporizers

Check Blue 15 No co-payment

 

Peak flow meters and spacers, for patients with asthma

Check Blue 15 No co-payment check red 15 0% – 20% co-insurance depending on plan level

Supplies for patients with diabetes

Check Blue 15 No co-payment check red 15 0% – 20% co-insurance depending on plan level

Tufts Health Plan patients who are exempt from pharmacy co-payments

 

Together

Direct*

Patients younger than 21

Check Blue 15  

 

American Indians and Alaskan Natives from federally recognized tribes

Check Blue 15 check red 15

Women who are pregnant or whose pregnancy ended less than 60 days prior

Check Blue 15 check red 15

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

Check Blue 15 check red 15

Patients in hospice care

Check Blue 15 check red 15

Patients who have reached their pharmacy co-payment cap for the calendar year

Check Blue 15 check red 15

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

plans card