CO-PAYMENT CHANGE
Please be advised that pharmacy co-payments will change as of May 1, 2014. Co-payments will once again be assessed on the total allowed charge for the prescription, regardless of preferred or non-preferred status.
The table below displays the new co-payment structure. All member categories previously excluded from co-pays will continue to be excluded.
| Total Allowed Charge | Co-Payment |
|---|---|
| $0.00 - 5.00 | $0.00 |
| $5.01 - 10.00 | $0.50 |
| $10.01 - 25.00 | $1.00 |
| $25.01 - 50.00 | $2.00 |
| $50.01 and above | $3.00 |
Beginning April 1, 2014, members will have a maximum out-of-pocket payment. The most the member will be required to pay for prescription drugs is displayed in the table below.
| Tier Level and Federal Poverty Level | Maximum Out-of-Pocket per Household |
|---|---|
| 1 (Below 50% of FPL | $8.00 |
| 2 (50.01% - 100% of FPL) | $71.00 |
| 3 (100.01% - 150% of FPL) | $143 |
