Drug Costs
Depending on your age and other factors listed below, you may need to pay a small fee (of $1) per covered prescription.* This fee is also called a copay.
| Type | Tier 1 New Hampshire Medicaid Preferred Drugs |
Tier 2 New Hampshire Medicaid Non-Preferred Drugs |
Tier 3 All other WellSense New Hampshire Medicaid Covered Drugs |
|---|---|---|---|
| Retail (1-month supply) |
$1.00 | $1.00 | $10.00 |
|
Mail Order |
$1.00 | $1.00 | $1.00 |
- You fall under the designated income threshold (100% or below the federal poverty level);
- You are under age 18 years;
- You are in a nursing facility or in an intermediate-care facility for individuals with intellectual disabilities;
- You participate in one of the Home and Community-Based Care (HCBC) waiver programs;
- You are pregnant and receiving services related to your pregnancy or any other medical condition that might complicate your pregnancy;
- You are receiving services for conditions related to your pregnancy and your prescription is filled or refilled within 60 days after the month your pregnancy ended;
- You are in the Breast and Cervical Cancer program;
- You are receiving hospice care; or
- You are a Native American or Alaska native
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