Leqvio: To start the application process apply to Leqvio Service Center at or (833) 537-8462. Kesimpta: To start the application process apply to Alongside™ Kesimpta at or (855) 537-4678. Novartis Oncology Products: To start the application process apply to PANO (Patient Assistance Now Oncology) at or (800) 282-7630. New application, new documentation yearly Must be residing in the US or US territoryĬomplete section, sign, attach required documents Novartis Patient Assistance Foundation, Inc. Provided by: Novartis Pharmaceuticals Corporation (NPAF) This program provides medication at no cost. Members who have accumulated copayment charges totaling their member-specific monthly copay cap on pharmacy services do not have to pay further MassHealth copays during the month in which the member reached the copay maximum.Novartis Patient Assistance Foundation, Inc.
Members who were a foster care child and are eligible for MassHealth Standard, until age 21 or 26.Members admitted to a hospital from such a facility or hospital.Intermediate-care facility for individuals with intellectual disabilities.Chronic-disease or rehabilitation hospital, or.
Members in a long-term care facility such as:.Members with MassHealth Senior Buy-In or MassHealth Standard, and who are receiving a drug that is covered under Medicare Parts A and B only, when provided by a Medicare-certified provider.Members who are receiving benefits under MassHealth Limited (Emergency Medicaid).Members who are pregnant or have recently given birth (are in their postpartum period).Members who are eligible for MassHealth because they are receiving certain public assistance benefits such as Supplemental Security Income (SSI), Transitional Aid to Families with Dependent Children (TAFDC), or services through the Emergency Aid to the Elderly, Disabled and Children (EAEDC) Program.Members with income at or below 50% of the federal poverty level (FPL).The following members are excluded from copays: MassHealth members are responsible for MassHealth copays, unless they meet one of the exclusions specified in the regulations at 130 CMR 450.130(D). For TTY, they can call (800) 497-4648 during the same hours.
If members have questions about the copay policy, they can reach the MassHealth Customer Service Center (CSC) at (800) 841-2900, Monday through Friday between 8:00 a.m. If you need help identifying the appropriate PBM, please call the MassHealth Customer Service Center at (800) 841-2900. If the pharmacy claims processing system incorrectly shows that there is a copay due, the pharmacist should call the appropriate Pharmacy Benefit Manager (PBM). When a member presents that letter, the provider should not charge the member a copay. MassHealth sends a letter to the member when the member has reached their copay cap. The pharmacy claims processing system should not indicate a copay amount if one isn’t required. Once the member has been charged the maximum in copays during a given month, the member will no longer have to pay copays until the next month. This limit does not apply to CommonHealth members.Įach family member has their own cap. MassHealth premiums are not more than 3% of the member’s monthly household income, as applicable.
Any drugs that are charged through Health Safety Net (HSN) are subject to the $250 annual pharmacy copay cap. This copay policy does not apply to Children’s Medical Security Plan (CMSP) members. If the member’s household income or family size changes in August, their monthly copay cap may change for August. The member’s final monthly copay cap will be:įor example, if a member’s monthly copay cap is $12.50 in July, the member is not charged more than $10 of copays in July. If the member’s monthly copay cap is calculated to be:
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