MassHealth drug costs

Check to see if your drug is covered and the cost to you.

MassHealth has updated its list of covered drugs, effective 4/1/2023. Please use the link below to check if your drug is covered.

MassHealth copay information

Note: Starting May 1, 2023, MassHealth will temporarily suspend (or pause) copays for all members. Copays for all drugs will be $0 for a period of time. 

Drug copays are listed below. These copays apply to both one-month and three-month supplies.

  • Select preventative drugs: $0 copay
  • Select generic drugs: $1 copay
  • All other medications: $3.65 copay

Members 19 years of age and older may need to pay a portion of the cost of covered drugs that may be obtained at the retail and mail order pharmacies until the member has met their annual copay cap. This out-of-pocket copay is collected at the pharmacy at the time the prescriptions are filled. 

MassHealth members may be exempt from paying a copay for drugs for any of the following reasons:

  • The member is under age 19
  • The member is pregnant (members must notify their doctor to submit a medical prior authorization form)
  • The member's pregnancy ended in the last 60 days (members must notify their doctor to submit a medical prior authorization form)
  • The member is in hospice care
  • The member is a Native American or Alaska Native from a federally recognized tribe
  • The member is receiving care as an inpatient in an acute hospital, nursing facility, chronic disease hospital, rehabilitation hospital or intermediate-care facility for the developmentally delayed

Monthly copay cap

Each member has a maximum amount that they can spend on copays each month called a monthly copay cap. Once the cap is reached, you will no longer have to pay copays on your prescriptions. 

For MassHealth, the monthly copay cap ranges from $0-60. Members will be notified by letter if they have reached the copay cap. 

Note: Pharmacies cannot refuse service to a MassHealth member who cannot pay the copay. However, the pharmacy may bill the member later for the copay.