MASSHEALTH, HSN AND COMMONWEALTH CARE CO-PAY INCREASES

Effective February 1, 2009, the pharmacy co-payments for MassHealth, Health Safety Net (formerly Free Care) and Commonwealth Care (Plan Type 1*) members will be as follows:

• Co-payment for generic drugs will remain at $1 for conditions like diabetes, hypertension and high cholesterol.
• Co-payment for generic drugs for all other conditions will be increased to $2.
• Co-payment for brand name drugs will remain at $3.

There is still an annual maximum of $200 on pharmacy co-payments for people on MassHealth, Health Safety Net and Commonwealth Care (Plan Type 1). Sometimes a copayment is not required. The rules for when a person does not have to pay a copay have not changed.

Copays for the Children’s Medical Security Plan (CMSP) and Healthy Start are not changing.

*Commonwealth Care Plan Type 1 includes those with income up to 100% FPL ($10,404 for an individual).

The patient notification letter is available in English and Spanish at: http://www.mass.gov/Eeohhs2/docs/masshealth/memlibrary/copays_e-sp.pdf. The notification also reminds MassHealth members about their rights if they can’t afford the co-pay- the pharmacy still must fill the prescription. However, the pharmacy can bill the member later.

-Adapted from: “Increase in Pharmacy co-payment for MassHealth, Health Safety Net and Commonwealth Care members” e-mail from Pragya Rizal, Assistant Manager, Public Payor Policy, Partners Community Benefits, January 14, 2009, and the member notification letter mentioned in article.

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