Please note

• When your Network Health patient can get generic drugs, we will not cover the brand-name drug unless we give you prior authorization. If we approve the brand-name drug, your Network Health patient will pay a Tier 3 co-payment.
• We will not cover drugs not on our Preferred Drug List (PDL) unless we give you prior authorization. If we approve a drug not listed on the PDL, your Network Health patient will pay a Tier 3 co-payment.

More co-payment information

For Network Health Forward^® (Commonwealth Care) and Network Health Extend (Medical Security Program) Plan Type II members, we cover the following with a prescription and no co-payment:

• Family-planning drugs and supplies
• Humidifiers and vaporizers
• Peak flow meters and spacers, for members with asthma
• Supplies for members with diabetes

For Network Health Forward and Network Health Extend Plan Type III members, we cover the following with a prescription and no co-payment:

• Family-planning drugs and supplies

For Network Health Forward and Network Health Extend Plan Type III members, we cover the following with a prescription and a 10% co-payment (10% of the total cost of the prescription)  

• Humidifiers and vaporizers
• Peak flow meters and spacers, for members with asthma
• Supplies for members with diabetes

Patients who do not have to pay co-payments

The following populations are exempt from pharmacy co-payments:

Network Health Forward and Network Health Extend Plan Type II and III:

• Women who are pregnant or whose pregnancy ended less than 60 days prior
• Patients in nursing facilities, immediate-care facilities for the developmentally delayed, or hospitals serving patients with acute, chronic-disease, or rehabilitation needs
• Patients in hospice care
• Patients who have reached their pharmacy co-payment cap (unless their eligibility changes from Plan Type II to Plan Type III)