Prescription 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 copayment.

  Tier 1 Tier 2 Tier 3

 

Supply Type

New Hampshire Medicaid 
Preferred 
Drugs
New Hampshire Medicaid 
Non-Preferred 
Drugs
All Other Well Sense
Covered Drugs

Retail

(1-Month Supply)

 

$1.00

 

$1.00

 

$1.00

Mail-Order 

(3-Month Supply)

 

$1.00

 

$1.00

 

$1.00

You will not have to pay a copayment if:

  • 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

*Pharmacies may not refuse to fill your prescription if you can’t pay the fee. However, the pharmacist may bill you for the fee.


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2021 Drug List

2021 Pharmacy Changes

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New for 2021! Starting in January we're updating our Pharmacy Benefits to help improve your overall member experience. View our member FAQs for more information.

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What's the difference between a generic and brand-name drug?

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When a company makes a new drug for the first time, they are the only ones who can sell it for a certain number of years. This is a brand-name drug. After that time, other companies can make and sell the same drug under a different name, making it a generic drug.