Copayments.
Some Medicaid members are required to make copayments when receiving pharmacy services. Others do not have to make these payments. See the following list of pharmacy services that require copayments and information about who does not have to make copayments. If you have questions, please call Customer Service at 1-800-447-8255. If you have a pharmacy benefit question, please call HIP Pharmacy Customer Services at 1-888-447-7364, Monday through Friday, 8 am to 6 pm.
| Services | Copay |
|---|---|
| Generic Prescription Drugs | $1.00 for each prescription & refill |
| Brand Name Prescription Drugs | $3.00 for each prescription & refill |
| Over-the-Counter (OTC) Drugs (e.g., smoking cessation products, insulin) | $0.50 per item |
| Medical Supplies (e.g., hearing aid batteries, enteral formula, diabetes test strips, lancets and syringes) | $1.00 per item |
The maximum copayment per calendar year is $200.
There are no copayments for the following members and/or services:
- Members younger than 21 years old.
- Members who are pregnant. Pregnant women are exempt during pregnancy and for the two months after the month in which the pregnancy ends.
- Members in a Comprehensive Medicaid Case Management (CMCM) or Service Coordination Program.
- Members in an OMH or OPWDD Home and Community Based Services (HCBS) Waiver Program.
- Members in a DOH HCBS Waiver Program for Persons with Traumatic Brain Injury (TBI).
- Family Planning drugs and supplies like birth control pills and condoms.
- Drugs to treat mental illness (psychotropic) and tuberculosis.