MassHealth and Health Safety Net CoPay Increases

 

In late August, a MassHealth and Health Safety Copayment notice was mailed to members informing them of copay changes that are effective October 1, 2011. Effective October 1, 2011, MassHealth and Health Safety Net (HSN) copayments for drugs that currently have a $3 copayment are going up to $3.65, for both first-time prescriptions and refills. The copay for certain covered generic and over-the-counter drugs mainly used for diabetes, high blood pressure, and high cholesterol will not be changing, and will stay at $1. Also, there are now no MassHealth pharmacy copays for family-planning services and supplies, such as oral contraceptives, diaphragms and condoms, and contraceptive jellies, creams, foams, and suppositories.

Starting in 2012, the calendar year cap on the amount of copays will go up from $200 to $250.

If a prescription is covered by MassHealth and the member is not able to pay the copay at the time of the service, the pharmacy must still fill the prescription. The pharmacy can bill the member later.

The notice also provides details on certain drugs that will not have a copay change and a listing of circumstances in which a copay is not required. Members have also been provided with appropriate contact information in the event that they have questions.

-From MassHealth and Health Safety Net Copays, MA Health Care Training Forum, September 01, 2011.

Addendum:
These changes also apply to Commonwealth Care Plan Type I members.

The reason that the co-payment for brand name drugs is increasing from $3 to $3.65, rather than to a round number, like $4, is because $3.65 is the maximum nominal pharmacy co-pay allowed under federal Medicaid regulation.

-Addendum from: "MassHealth and HSN pharmacy co-pay changes", Kim Simonian, MPH, Associate Director, Patient Access, Partners HealthCare - Community Health, e-mail dated , September 28, 2011.

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