Effective January 1, 2014, MassHealth changed its member copayment rules for pharmacy and nonpharmacy-related services.
Pharmacy copayments for drugs covered under MassHealth, which include both first-time prescriptions and refills, are:
- $1.00 for certain covered generic drugs and over-the-counter drugs mainly used for diabetes, high blood pressure, and high cholesterol. These drugs are called antihyperglycemics (such as metformin), antihypertensives (such as lisinopril), and antihyperlipidemics (such as simvastatin); and
- $3.65 for each prescription and refill for all other generic, brand-name, and over-the-counter drugs.
Posting Requirements
As required in MassHealth’s regulations at 130 CMR 450.130(F), pharmacies and hospitals must post a notice about copayments in areas where copayments are collected. The notice must be visible to the public and easily readable, specify the exclusions from the copayment requirement listed in 130 CMR 450.130(D) and (e), and instruct members to inform providers if members believe they are excluded from the copayment requirement.