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Pharmacy Copays
Some drugs require a copayment, which is the amount that you pay to the pharmacy when you receive your prescription or over-the-counter drugs.
You cannot be denied a prescription drug if you cannot pay the copayment. Tell your pharmacist if you cannot afford to pay. Your pharmacist can still try to collect the copayment.
Copayments are as follows:
- For adults:
- brand-name prescription drugs and brand-name over-the-counter drugs cost $3 for each new prescription or refill.
- Generic prescription drugs and generic over-the counter drugs cost $1 for each new prescription or refill.
- For children:
- Brand-name prescription drugs and brand-name over-the-counter drugs cost $0 for each new prescription or refill.
- Generic prescription drugs and generic over-the-counter drugs cost $0 for each new prescription or refill.
There are no copays for:
- Pregnant women (including the postpartum period which ends 12 months after delivery)
- Children under 18 years of age
- Medical benefit drugs
- Members in a nursing home
- Members receiving hospice care.
- Members in an Intermediate Care Facility for Mental Retardation or Intermediate Care
- Facility for Other Related Conditions
Family planning drugs or supplies
- Drugs, including immunizations, when dispensed and/or administered by a physician
- Title IV-B Foster Care and IV-E Foster Care and Adoption Assistance
- Members eligible under the Breast and Cervical Cancer Prevention and Treatment Programs
There is no copay for the following groups of medications:
- Antihypertensives (high blood pressure)
- Antidiabetes (high blood sugar)
- Anticonvulsants (seizure)
- Cardiovascular preparations (heart disease)
- Antipsychotics (except those that are controlled substance antianxiety drugs)
- Antineoplastic (cancer drugs)
- Antiglaucoma drugs
- Anti-Parkinson’s drugs
- HIV/AIDS drugs
- Preferred naloxone injection/nasal spray for drug overdose
Call GHP Family Pharmacy Services at 855-552-6028 or 570-214-3554:
Monday, Tuesday, Thursday, Friday: 8 a.m. – 7 p.m.; Wednesday: 8 a.m. – 8 p.m.; Saturday: 8 a.m. – 2 p.m.
To give medications to GHP Family members, Pennsylvania pharmacies must:
- Be enrolled with the PA Department of Human Services (DHS).
- Have a Pennsylvania Medicaid ID number. Check that the pharmacy has one before you give them your prescription.
Geisinger Health Plan (GHP) follows the Statewide Preferred Drug List (PDL). So do other Medicaid Medical Assistance managed care organizations. The Department of Human Services’ Pharmacy and Therapeutics Committee develops the Statewide PDL. Medications not on the PDL follow the GHP Family Formulary. Click to see the Statewide Preferred Drug List (PDL).