Pharmacy Co-payments Effective May 1, 2014

CO-PAYMENT CHANGE

Please be advised that pharmacy co-payments will change as of May 1, 2014. Co-payments will once again be assessed on the total allowed charge for the prescription, regardless of preferred or non-preferred status.

The table below displays the new co-payment structure. All member categories previously excluded from co-pays will continue to be excluded.

​Total Allowed Charge ​Co-Payment
​$0.00 - 5.00 ​$0.00
​$5.01 - 10.00 ​$0.50
​$10.01 - 25.00 ​$1.00
​$25.01 - 50.00 ​$2.00
​$50.01 and above ​$3.00

 

Beginning April 1, 2014, members will have a maximum out-of-pocket payment. The most the member will be required to pay for prescription drugs is displayed in the table below.

 

​Tier Level and Federal Poverty Level ​Maximum Out-of-Pocket per Household
​1 (Below 50% of FPL ​$8.00
​2 (50.01% - 100% of FPL) ​$71.00
​3 (100.01% - 150% of FPL) ​$143

 

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