How much are copayments?
DMAP charges a $3 copayment for certain types of outpatient services, and a $1 or $3 copayment for certain prescription drugs. The copayment amount depends on the type of prescription filled: • $1 for non-preferred Preferred Drug List (PDL) drugs and non-PDL generics costing more than $10; no copayment for preferred PDL generics, non-PDL generics costing less than $10, and preferred PDL brands; • $3 for all other non-PDL brand-name drugs. When a client has other health coverage resources (third-party liability, or TPL, which includes Medicare), the copayment amount depends on how much TPL has paid for the service and the amount DMAP would normally pay for the service. For example, with a service requiring a $3 DMAP copayment: • If DMAP would pay less than $3 after TPL pays, then a less-than-$3 copayment applies. If DMAP would only pay $1 after TPL pays, then DMAP would take $1 (not $3) from what it pays to the provider. The provider may collect a $1 copayment from the client. • If DMAP
