Skip to navigation Skip to content Skip to footer
Tier Copay Amount
Tier 1
Generic drugs
$0 copay or $1.30 to $3.70 copay for a 30-day supply,
depending on your income and
level of Medical Assistance (Medicaid) eligibility
Tier 1
Brand drugs
$0 copay or $4.00 to $9.20 copay for a 30-day supply,
depending on your income and
level of Medical Assistance (Medicaid) eligibility
Over-the-Counter $0 copay