Reduced copay prescription drug coverage for Massachusetts chronic conditions
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Describes reduced copay amounts for certain prescription drugs for Aetna members in Massachusetts with specified chronic conditions, effective starting July 1, 2025 and extending through 2026 with annual updates.
No material clinical or coverage changes in this revision.
Reduced Copay Coverage Criteria
Reduced copay coverage criteria
Covered when ALL of the following are met:
ALL of the following
$0 copay — generic drugs
- ALBUTEROL (generic) — $0 copay
- SOTALOL (generic) — $0 copay
- METOPROLOL/HYDROCHLOROTHIAZIDE (generic) — $0 copay
$25 copay — brand-name and insulin products
- BREO ELLIPTA — $25 copay
- ELIQUIS — $25 copay
- BRILINTA — $25 copay
- Insulin products (NOVOLIN 70/30 FLEXPEN; NOVOLIN N FLEXPEN; LANTUS SOLOSTAR; NOVOLOG; NOVOLIN R; TRESIBA FLEXTOUCH) — $25 copay
Drug Lists and Effective Period
| ALBUTEROL — $0 copay | |
| SOTALOL — $0 copay | |
| METOPROLOL/HYDROCHLOROTHIAZIDE — $0 copay |
| BREO ELLIPTA — $25 copay | |
| ELIQUIS — $25 copay | |
| BRILINTA — $25 copay | |
| NOVOLIN 70/30 FLEXPEN — $25 copay | |
| NOVOLIN N FLEXPEN — $25 copay | |
| LANTUS SOLOSTAR — $25 copay | |
| NOVOLOG — $25 copay | |
| NOVOLIN R — $25 copay | |
| TRESIBA FLEXTOUCH — $25 copay |
Member Assistance and Provider Guidance
Member assistance and scope
Starting July 1, 2025, Massachusetts law provides lower copays for certain prescription drugs for members with qualifying chronic conditions (examples: asthma, diabetes, and two specified heart problems). For questions or help confirming member eligibility or coverage, contact Member Services using the number on the back of the member’s ID card.
Qualifying Chronic Conditions
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