Pharmacy Benefits

Over-the-counter medications

MedStar Family Choice does pay for some over-the-counter medications. In order to receive these medications, your doctor must write a prescription or call a prescription in to your pharmacy. 

Your doctor can include a limited number of refills on the prescription so that you do not have to call your doctor each time you run out of one of these medications. These medications are available as generics (not name brand).

Condoms are available without a prescription at the pharmacy counter. 

Co-pays and other insurance

Beginning on May 1, 2024, MedStar Family Choice is required by the Maryland Department of Health to have a copay (cost) for most prescription medicines.

• For most formulary (covered) brand name or generic medicines there is a copay (cost) of $1.00
• Some formulary (covered) brand medicines will have a copay (cost) of $3.00, these are marked as “Tier 2” on the formulary
• For HIV/AIDS medicine you will have a copay (cost) of $1.00.
• There is NO cost for family planning options (condoms, IUD, birth control pills, etc.).
• For non-formulary (non-covered) brand name medicines you will have a copay (cost) of $3.00.

Please note that the following MedStar Family Choice members will not have a copay for their medicine.

• Members under the age of 21
• Members who are pregnant people
• Members who are in hospice care (programs that give special care to people who are near the end of life and have stopped treatment to cure or control their illness/disease).
• Members who are Native Americans

If you are taking a medicine for mental health or certain seizure medicines, that coverage is not through MedStar Family choice, but through the State of Maryland. These medicines are not paid for by MedStar Family Choice; the State of Maryland decides which medicines are covered and any costs for those prescriptions. Please review the Maryland Department of Health preferred drug list for the listing of covered medications.

MedStar Family Choice is always your secondary insurance. You should tell your doctor you have two types of insurance so they can make sure the medicine prescribed is approved by both of your insurance companies. If you have other insurance, please give both cards to the pharmacist. Your other insurance will pay for most of the costs and MedStar Family Choice will pay for the difference between the costs from your primary insurance and the amount of copay you would have from MedStar Family Choice.