Get Prescriptions

BMC HealthNet Plan is committed to providing quality and affordable medications for Massachusetts members through our prescription drug benefit.

Prescription Drug Overview

Our prescription drug benefit offers:


  • Coverage of thousands of medications. See if a drug is covered.

  • Coverage of some over-the-counter drugs like aspirin or certain allergy medicines. Learn how to get over-the-counter drugs.

  • Affordable copayments for generic medications. Find out how much your prescription drug will cost below.

  • Choose from over 1,000 chain and independent retail pharmacies throughout Massachusetts to get prescriptions filled, or get certain prescriptions mailed to your home through our mail order program.

  • Medications for members with rare or chronic health conditions. Your provider may obtain injectables and biotech drugs through our specialty pharmacy networks.

Picking up Prescriptions

You can pick up your prescriptions at a local pharmacy or have your daily medicines mailed to your home.

  • Find a Pharmacy: Find a pharmacy or specialty pharmacy near you by using our tool. Certain medicines, like injectable drugs, are only available through specialty pharmacies. Your doctor will deliver your medicines to a specialty pharmacy and tell you where to pick them up.
  • Mail Order Pharmacy: Get a three-month supply of a prescription mailed to you for the cost of a one-month supply and save a trip to the pharmacy. This is only available for certain medicines that you use every day (like high blood pressure or cholesterol medicines). You can enroll through our partner, EnvisionMail, at envisionpharmacies.com or call 866-909-5170.

Prescription Costs

Some covered drugs may have a small cost (called a “copay” or "copayment"). Select your plan below to learn what your prescriptions will cost. Some members don't have to pay a copay for prescriptions. 

Drug Type

Tier

Retail Copay
(1 month supply)

Mail Order Copay
(3 month supply)

Generic Drugs
For high blood pressure, high cholesterol & diabetes

Tier 1

$1

$1

Generic Drugs
All covered over-the-counter and prescription drugs

Tier 1

$3.65

$3.65

Brand Drugs

Tier 2

$3.65

$3.65

Members (19 years of age and older) may need to pay a portion of the cost of covered drugs that may be obtained at the retail and mail order pharmacies until the member has met their annual copayment cap. This out-of-pocket copayment is collected at the pharmacy at the time the prescriptions are filled. To find out what copayment tier your medication is in use our Drug Finder

MassHealth members may be exempt from paying a copayment for drugs for any of the reasons below – see the full list.

  • The member is under the age of 19.
  • The member is pregnant (members must notify their doctor to submit a Medical Prior Authorization Form).
  • The member’s pregnancy ended in the last 60 days (members must notify their doctor to submit a Medical Prior Authorization Form).
  • The member is in hospice care.
  • The member is a Native American or Alaska Native from a federally recognized tribe. 
  • The member is receiving care as an inpatient in an acute hospital, nursing facility, chronic disease hospital, rehabilitation hospital, or intermediate-care facility for the developmentally delayed.

Annual Copayment Cap

Each member has a maximum amount that they can spend on copayments each year called an annual copayment cap. Once the cap is reached you will no longer have to pay copays on your prescriptions. MassHealth members are on calendar year from January to December. 

Plan Type


Annual Copayment Cap


MassHealth

$250

Members will be notified by a letter if they have reached the copayment cap.

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

To view your prescription costs, select your Plan Type below and scroll down to the Prescription Drug section. You may find the tier of a prescription drug by searching our Drug Finder.

ConnectorCare
Qualified Health Plans
 

ConnectorCare and Qualified Health Plan members may be exempt from paying a copayment for the following reasons:

  • The member is receiving family planning supplies and/or family planning services
  • The member has met the annual copayment cap when applicable

Annual Copayment Cap

Each member has a copayment cap on out-of-pocket expenses based on the member's plan type. Once the annual out-of-pocket maximum is reached, you will no longer be required to contribute towards the cost of your prescriptions.

Plan Type Annual Copay Cap

ConnectorCare/Qualified Health Plan

$200

Members will be notified by letter if they have reached the copayment cap. 

You can register/log in to envisionrx.com to find the cost of a specific drug.

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