Prescription Copays for Medicaid Members Are Back. Here's What You Need to Know!
Date: 06/05/23
Members: Now that the public health emergency (PHE) for COVID-19 has ended, your medicine coverage will return to the way it was before. That means you may have to pay a copay for some covered medications again. This copay won’t be more than $3 for covered medications.
Important: You will also now have to provide a signature when you pick up your medicine or have it delivered.
What is a copay?
For many members, like those younger than 21, medications are covered at no cost. But some members may need to pay for a small portion of their medications. This is called a “copay” or “copayment.”
Your copays range from $0.50 to $3.00 depending on the cost of the prescription. The table below lists copays based on the actual cost of the prescription.
PRESCRIPTION COST | COPAY |
|---|---|
$10.00 or less | $0.50 |
Between $10.01 and $25.00 | $1.00 |
Between $25.01 and $50.00 | $2.00 |
More than $50.01 | $3.00 |
Remember: The total amount you pay for prescription medicine can’t be more than 5% of your family’s income each month. Once you reach this limit, you won’t have any more copays for the rest of the month.
There are no copays for:
- Emergency services
- Family planning supplies
- Certain preventive medications
There are no copays for members who are:
- Pregnant
- Members under the age of 21
- In a long-term care facility
- In hospice care
- Native Americans
- Alaska Natives
- Home and Community Based Waiver recipients
- Eligible for Medicaid due to breast or cervical cancer
If you have questions about your copayments or this change, please call 1-866-595-8133 (TTY: 711) Monday – Friday, 7 a.m. to 7 p.m.