Commonwealth Care II / III
Commonwealth Care II and III Pharmacy Copayments
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 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 copayments depending on which plan type they have. Members may be exempt from paying a copayment if the member has met the annual copayment cap or receiving family planning supplies and/or family planning services.
Retail Pharmacy Copayments
(One-month supply)
|
Drug Type |
Commonwealth Care |
|
|
Plan II |
Plan III |
|
|
Generic drugs |
$10 |
$12.50 |
|
Preferred drugs |
$20 |
$25 |
|
Non-Preferred drugs |
$40 |
$50 |
Mail Order Pharmacy Copayments
(Three-month supply)
|
Drug Type |
Commonwealth Care |
|
|
Plan II |
Plan III |
|
|
Generic drugs |
$20 |
$25 |
|
Preferred drugs |
$40 |
$50 |
|
Non-Preferred drugs |
$120 |
$150 |
Annual Copayment Cap
Each member has an annual calendar copayment cap on out-of-pocket expenses from July to June of each plan year.
Once the annual out-of-pocket maximum is reached, you would no longer be required to contribute towards the cost of your prescriptions. See the table below for individual copayment caps:
|
Plan Type
|
Annual Copayment Cap
|
|
Commonwealth Plan II
|
$500
|
|
Commonwealth Plan III
|
$800
|
Members will be notified by a letter if they have reached the copayment cap.
