Traditional MedicareReimbursementMedium impact
2025.60 - Medicare Part D Co-pays for Dual Eligible HUSKY Low Income Subsidy Clients
Connecticut Medicaid (HUSKY Health)·CT·Provider Bulletin
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Effective January 1, 2026, Medicare Part D co-pays for dual eligible HUSKY clients are changing: generic drug co-pays increase from $4.90 to $5.10, while other drug co-pays remain at $12.65. All Medicare Part D claims must be submitted to Gainwell Technologies for proper tracking of the $17 monthly co-pay limit, and claims with co-pays exceeding $12.65 will be automatically denied.
Action Required
Before January 1, 2026: Pharmacy billing team must update systems to reflect new Medicare Part D co-pay amounts ($5.10 for generics, $12.65 maximum for all drugs) and ensure all Medicare Part D claims for dual eligible HUSKY clients are submitted to Gainwell Technologies rather than self-calculating co-pays. Update billing software to reject co-pay-only claims exceeding $12.65 as they will be automatically denied.