In order to qualify for CoverRx, applicants must earn within 250 percent of the federal poverty level (FPL) — $55,875 for a family of four.

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

Persons in Household	Below FPL	FPL to 149% FPL	150% to 250% FPL
1	$10,889	$10,890 - $16,334	$16,335 - $27,225
2	$14,709	$14,710 - $22,064	$22,065 - $36,775
3	$18,529	$18,530 - $27,794	$27,795 - $46,325
4	$22,349	$22,350 - $33,524	$33,525 - $55,875
5	$26,169	$26,170 - $39,254	$39,255 - $65,425
6	$29,989	$29,990 - $44,984	$44,985 - $74,975
7	$33,809	$33,810 - $50,714	$50,715 - $84,525
8	$37,629	$37,630 - $56,444	$56,445 - $94,075

For families with more than eight persons, add $3,740 for each additional person to calculate the low copay level.
Rates effective as of 3/1/11.