In order to qualify for CoverRx, applicants must earn within 250 percent of the federal poverty level (FPL) — $55,125 for a family of four.

Copays for prescriptions are based on a member's household income, as outlined below.

Persons in Household	At or Below FPL	101% to 150% FPL	151% to 250% FPL
1	$10,830	$10,831 - $16,245	$16,246 - $27,075
2	$14,570	$14,571 - $21,855	$21,856 - $36,425
3	$18,310	$18,311 - $27,465	$27,466 - $45,775
4	$22,050	$22,051 - $33,075	$33,076 - $55,125
5	$25,790	$25,791 - $38,685	$38,686 - $64,475
6	$29,530	$29,531 - $44,295	$44,296 - $73,825
7	$33,270	$33,271 - $49,905	$49,906 - $83,175
8	$37,010	$37,011 - $55,515	$55,516 - $92,525

For families with more than eight persons, add $3,740 for each additional person to calculate the low copay level.
Rates effective as of 6/1/10.