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CommUnityCare – Women’s Health Center
Pharmacy Copayments
Created On
Last Updated On
byMike McKinnon, Communications Solutions & Innovation Manager
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| Program | Plan Level | Formulary Copay | Formulary Copay | Non-Formulary Copay | Non-Formulary Copay |
|---|---|---|---|---|---|
| Less than or equal to 30-day supply | Greater than or equal to 31-day supply | Less than or equal to 30-day supply | Greater than or equal to 31-day supply | ||
| MAP | CBRACKFQ-H | $0 | $0 | $0 | $0 |
| CBRACKFQ | $7 | $14 | $10 | $20 | |
| MAP BASIC | BASIC 000 | $0 | $0 | $0 | $0 |
| BASIC 100 | $7 | $10 | $14 | $20 | |
| BASIC 150 | $8 | $13 | $16 | $26 | |
| BASIC 175 | $9 | $14 | $18 | $28 | |
| BASIC 200 | $10 | $15 | $20 | $30 | |
| MAP Dental | CHAP | Not a CHAP Benefit | Not a CHAP Benefit | Not a CHAP Benefit | Not a CHAP Benefit |
*Provider organizations may offer pharmacy copay discounts