You can get drugs we cover with a doctor’s prescription and a co-payment. If you want to figure out your co-payment for a specific drug, use our drug lookup tool. For general information on pharmacy co-payments, see the chart below.

*Pharmacy co-payments for covered generic, preferred brand name, and select over-the-counter drugs are $3.65. Generic drugs and select over-the-counter drugs for diabetes, high blood pressure, and high cholesterol have a $1 co-payment.

Please note

• When you can get generic drugs, we will not cover the brand-name drug unless we have given you prior authorization. If we approve the brand-name drug, you will pay a Tier 2 or Tier 3 co-payment depending on your Plan Type.

• We will not cover drugs that are not on our Preferred Drug List (PDL) unless we have given you prior authorization. If we approve a drug not listed on the PDL, you will pay a Tier 2 or Tier 3 co-payment depending on your Plan Type. 

More co-payment information

• For Commonwealth Care Plan Type I members, we cover family-planning drugs and supplies with a prescription and no co-payment.

• For Commonwealth Care Plan Type III members with asthma, we cover peak flow meters and spacers with a prescription and 10% co-payment (10% of the total cost of the prescription). There is no co-payment for Plan Types I and II members.

• For Commonwealth Care Plan Type III members with diabetes, we cover testing supplies with a prescription and 10% co-payment (10% of the total cost of the prescription). There is no co-payment for Plan Types I and II members.