Budget Amendment ID: FY2012-S3-436

EHS 436

MassHealth Pharmacy Copayment

Ms. Fargo and Messrs. Rodrigues and Finegold and Ms. Chandler and Mr. Joyce moved that the proposed new text be amended by inserting, after Section 152, the following new Section:-

"SECTION 153. Section 25 of chapter 118E of the General Laws, as appearing in the 2008 Official Edition, is hereby amended by striking out paragraph 4 of subsection (5) and inserting in place thereof the following paragraph:-

Notwithstanding the first paragraph of this section, the division may require medicaid recipients to pay enrollment fees, premiums, deductibles, coinsurance, copayments or similar cost-sharing charges as participants in managed care plans implemented by the division, so long as any waivers of Title XIX provisions regarding recipient cost-sharing are obtained from the secretary in conjunction with any other federal approvals and waivers necessary to implement these managed care plans. In the absence of managed care plans, the division shall require, to the extent permitted by federal law, that recipients, if eligible for such benefits, be liable for a copayment of up to $5 toward the purchase of each pharmaceutical product, including prescription drugs and over-the-counter drugs, provided that copayments for pharmaceutical products greater than $3 are mandatory and must be paid in full; and to require copayment of $5 for the use of emergency room services in acute care hospitals for the treatment of nonemergency conditions. The division may also require, to the extent permitted by federal law, that recipients be liable for a copayment of up to $5 for all other covered services with the exception of mental health and substance abuse services. The division shall establish a per-member out-of-pocket cap for all copayments."