Commonwealth Care members must pay a portion of the cost
of covered drugs that may be obtained through the retail and mail order
pharmacies. This out-of-pocket copayment is collected at the pharmacy at the
time the prescriptions are filled or when the member submits the mail order
prescription. Members may pay different out-of-pocket copayments depending on
which plan type they have. Certain members may be exempt from paying a
copayment, click here
to see the copayment exemption rules.
Drugs are sorted into tiers, or levels of cost, as defined below.
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Tier 1 drugs are generally generic drugs or OTC drugs and have lower
copayments.
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Tier 2 drugs are generally brand name drugs and have higher copayments.
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Tier 3 drugs are generally non-preferred brand name drugs and have the highest
copayments.
The BMC HealthNet Plan Formulary allows members and providers
to search for a specific drug and confirm its tier assignment. Users are
reminded to choose the member’s correct plan type before looking up a drug in
order to obtain accurate tier information. After determining which tier a
covered drug belongs to, the user may look up the tier and member plan type in
the chart above to determine the actual out-of-pocket copayment.
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