Get prescriptions
WellSense is committed to providing quality and affordable medications for Massachusetts members through our prescription drug benefit.
Check drug coverage
Find out if your medication is covered and what your cost (or copay) will be.
- If you find there are limitations on your drug, please see the Formulary Guidebook (2023) or Formulary Guidebook (2024) for more information.
- Certain medicines are only available through specialty pharmacies.
- Maintenance medications may be eligible for our mail order home delivery program.
Our prescription drug benefit offers:
- Coverage of thousands of medications
- Coverage of nondrug pharmacy items
- Coverage of some over-the-counter drugs like aspirin or certain allergy medicines
- Affordable copays for generic medications
- Choose from more than 1,000 chain and independent retail pharmacies throughout Massachusetts to get prescriptions filled, or get certain prescriptions mailed to your home through our mail order program.
- Medications for members with rare or chronic health conditions. Providers may obtain injectables and biotech drugs through our specialty pharmacy networks.
- Find a Pharmacy
- If there are limitations on your drug please see the Formulary Guidebook for more information.
Drug costs
The drug formulary is more than just a list of medications. It can also help you figure out what your cost (or copay) for a medication will be and whether there is a lower cost option. Select your plan below to search the formulary. Note: “SG” plan members should choose their metallic plan name from the lists below.
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Our prescription drug benefit offers:
- Coverage of thousands of medications.
- Coverage of nondrug pharmacy items
- Coverage of some over-the-counter drugs like aspirin or certain allergy medicines
- Affordable copays for generic medications. Find out how much your prescription drug will cost below.
- Choose from more than 1,000 chain and independent retail pharmacies throughout Massachusetts to get prescriptions filled, or get certain prescriptions mailed to your home through our mail order program.
- Medications for members with rare or chronic health conditions. Your provider may obtain injectables and biotech drugs through our specialty pharmacy networks.
Our prescription drug benefit offers:
- Coverage of thousands of medications.
- Coverage of non-drug pharmacy items
- Coverage of some over-the-counter drugs like aspirin or certain allergy medicines
See what medications, non-pharmacy items and over-the-counter drugs are covered:
Qualified Health Plan Medications
- If there are limitations on your drug please see the ConnectorCare and QHP Formulary Guidebook for more information:
- Affordable copayments for generic medications. Find out how much your prescription drug will cost.
- Choose from over 1,000 chain and independent retail pharmacies throughout Massachusetts to get prescriptions filled, or get certain prescriptions mailed to your home through our mail order program.
- Medications for members with rare or chronic health conditions. Your provider may obtain injectables and biotech drugs through our specialty pharmacy networks.
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Picking up Prescriptions
You can pick up your prescriptions at a local pharmacy or have your daily medicines mailed to your home.
- Find a Pharmacy: Find a pharmacy or specialty pharmacy near you by using our tool. Certain medicines, like injectable drugs, are only available through specialty pharmacies. Your doctor will deliver your medicines to a specialty pharmacy and tell you where to pick them up.
- Mail Order Pharmacy: Get a three-month supply of a prescription mailed to you for the cost of a one-month supply and save a trip to the pharmacy. This is only available for certain medicines that you use every day (like high blood pressure or cholesterol medicines). You can enroll through our partner, Cornerstone Health Solutions, by calling them at 844-319-7588 or completing the Mail Order Enrollment Form and faxing it to (781)-805-8221 or emailing it to CornerstoneMailOrderPharmacy@BMC.org.
2024 WellSense Clarity plan drug costs
Understanding drug tiers for your planWhen searching for a drug, pay attention to the drug tier listed next to it to find your copay cost. If no tier is listed, there may be a restriction on that particular drug, and you may need to try another medication first. In some cases, your doctor needs to ask us for approval to prescribe you a medication before we can cover it. Find your plan type below to see the cost for each drug tier. "SG" plan members should choose the metallic name (Silver, Gold, etc.) that matches their plan.
You can also view your prescription costs in the Prescription Drug section of the Schedule of Benefits.
Retail prescriptions (1-month supply)
| Plan name | Tier 1 generic drugs | Tier 2 preferred brand drugs | Tier 3 non-preferred brand & specialty drugs |
|
ConnectorCare 1 |
$1 | $3.65 | $3.65 |
|
ConnectorCare 2 |
$10 | $20 | $40 |
| ConnectorCare 3 | $12.50 | $25 | $50 |
| Platinum 0 Deductible | $10 | $25 | $50 |
| Gold 0 Deductible | $30 | $60 | $90 |
| Gold 1500 | $30 | $60 after deductible | $90 after deductible |
| Silver 2000 | $30 | $55 | $75 after deductible |
| Silver 2000 II | $30 | $55 | $75 after deductible |
| Silver 3000 | $30 after deductible | 35% after deductible | 35% after deductible |
| Bronze HSA 3600 | $30 after deductible | $120 after deductible | $200 after deductible |
| AIAN Zero & Limited Cost Share | $0 | $0 | $0 |
Mail-order prescriptions (3-month supply)
| Plan name | Tier 1 generic drugs | Tier 2 preferred brand drugs | Tier 3 non-preferred brand & specialty drugs |
|
ConnectorCare 1 |
$2 | $7.30 | $7.30 |
|
ConnectorCare 2 |
$20 | $40 | $80 |
| ConnectorCare 3 | $25 | $50 | $100 |
| Platinum 0 Deductible | $20 | $50 | $150 |
| Gold 0 Deductible | $60 | $120 | $270 |
| Gold 1500 | $60 | $120 after deductible | $270 after deductible |
| Silver 2000 | $60 | $110 | $225 after deductible |
| Silver 2000 II | $60 | $110 | $225 after deductible |
| Silver 3000 | $60 after deductible | 35% after deductible | 35% after deductible |
| Bronze HSA 3600 | $60 after deductible | $240 after deductible | $600 after deductible |
| AIAN Zero & Limited Cost Share | $0 | $0 | $0 |
2023 ConnectorCare and Qualified Health Plan drug costs
You can view your prescription costs in the Prescription Drug section of the Schedule of Benefits. You can find the tier of a prescription drug by searching our drug finder links below.
- ConnectorCare I
- ConnectorCare II
- ConnectorCare III
- Platinum
- Gold
- Low Gold
- Silver A
- Silver A II
- Silver B
- Low Silver
- Bronze
- Zero and Limited Share
When searching for a drug, pay attention to the drug tier listed next to it. Then find your plan type below to see the cost for that drug tier. If no tier is listed, there may be a restriction on that particular drug, and you may need to try another medication first. In some cases, your doctor needs to ask us for approval to prescribe you a medication before we can cover it.
Retail prescriptions (1-month supply)
| Plan name | Tier 1 generic drugs | Tier 2 preferred brand drugs | Tier 3 non-preferred brand & specialty drugs |
|
ConnectorCare I |
$1 | $3.65 | $3.65 |
|
ConnectorCare II |
$10 | $20 | $40 |
| ConnectorCare III | $12.50 | $25 | $50 |
| ConnectorCare Zero & Limited Cost Share Select | $0 | $0 | $0 |
| ConnectorCare Zero & Limited Cost Share Silver | $0 | $0 | $0 |
| Platinum | $10 | $25 | $50 |
| Gold | $30 | $60 | $90 |
| Low Gold | $30 | $60 after deductible | $90 after deductible |
| Silver A | $30 | $60 after deductible | $90 after deductible |
| Silver A II | $30 | $60 after deductible | $90 after deductible |
| Silver B | $30 after deductible | 35% after deductible | 35% after deductible |
| Bronze | $30 after deductible | $120 after deductible | $200 after deductible |
Mail-order prescriptions (3-month supply)
| Plan name | Tier 1 generic drugs | Tier 2 preferred brand drugs | Tier 3 non-preferred brand & specialty drugs |
|
ConnectorCare 1 |
$2 | $7.30 | $7.30 |
|
ConnectorCare 2 |
$20 | $40 | $80 |
| ConnectorCare 3 | $25 | $50 | $100 |
| ConnectorCare Zero & Limited Cost Share | $0 | $0 | $0 |
| Platinum 0 Deductible | $20 | $50 | $150 |
| Gold 0 Deductible | $60 | $120 | $270 |
| Gold 1500 | $60 | $120 after deductible | $270 after deductible |
| Silver 2000 | $60 | $110 | $225 after deductible |
| Silver 2000 II | $60 | $110 | $225 after deductible |
| Silver 3000 | $60 after deductible | 35% after deductible | 35% after deductible |
| Bronze HSA 3600 | $60 after deductible | $240 after deductible | $600 after deductible |
Tab content
Members may be exempt from paying a copay for the following reasons:
- The member is receiving family planning supplies and/or family planning services
- The member has met the annual out-of-pocket maximum when applicable
Each member has an out-of-pocket maximum based on the member's plan type. Once the annual out-of-pocket maximum is reached, you will no longer be required to contribute towards the cost of your prescriptions. You can find your yearly out-of-pocket maximum in your Schedule of Benefits. You can log in to the member portal to find the cost of a specific drug.
Glossary
Generic drugs: You will pay the lowest copay for generic drugs. Generics are equivalent to their brand-name counterparts, and are ensured by the Food and Drug Administration to be as safe and effective.
Preferred brand drugs: These are drugs covered by your pharmacy benefit when generic equivalents are not available.
Non-preferred brand drugs: These are brand-name drugs that are not covered under your pharmacy benefit but may be covered if they are a part of your medical benefit, another preferred drug is tried first, or prior approval is obtained
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