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.
* Copayments for covered generic and over-the-counter drugs (with a prescription) will be $2 EXCEPT
for certain covered generic drugs that members may take for high blood pressure, high cholesterol
or diabetes. The copayment for these will be $1. These drugs are called
antihypertensives (such as propranolol), antihyperlipidemics (such as simvastatin) and
antihyperglycemics (such as metformin). Please call one of the numbers below to find out your
copay if you don’t know.
Drugs are sorted into tiers, or levels of cost, as defined below.
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Generic drugs are generally generic drugs or OTC drugs and have lower
copayments.
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Preferred drugs are generally brand name drugs and have higher copayments.
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Non-Preferred 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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