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Prepaid Medical Assistance Program (PMAP) 2021 Formulary (List of Covered Prescription and Over-the-Counter Drugs)

Download the complete Formulary or search the list of covered drugs below.

Tier Copay Amount
Tier 1
Generic drugs
$1 copay
Tier 1
Brand drugs
$3 copay

Note:

  • No co-pays for pregnant women, children under 21, members in hospice, members residing in a nursing home for 30+ days, or adult members of a federally-recognized American Indian tribe.
  • No co-pays for anti-psychotic drugs
  • Copay Amount can vary based on income, call Customer Service to verify your copay.