MassHealth members (19 years of age and older) must pay a portion of the cost of covered drugs that may be obtained at the retail pharmacy. This out-of-pocket copayment is collected at the pharmacy at the time the prescriptions are filled. Certain members may be exempt from paying a copayment, click here to see the exemption copayment rules. The copayment amount is based on each prescription filled.

Retail Pharmacy Copayments
(One-month supply)

Mail Order Pharmacy Copayments
(Three-month supply)

Determining Tier Assignment and Member Copayment
Drugs are sorted into tiers, or levels of cost, as defined below.

• Tier 1 drugs are generally generic drugs or OTC drugs and have lower copayments.
• Tier 2 drugs are generally brand name drugs and have higher 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.

Note: Pharmacies may not refuse service to a MassHealth member who cannot pay the copayment. However, the pharmacist may bill the member later for the copayment.