In order to qualify for CoverRx, applicants must earn within 250 percent of the federal poverty level (FPL) — $57,625 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	$11,170	$11,171 - $16,755	$16,756 - $27,925
2	$15,130	$15,131 - $22,695	$22,696 - $37,825
3	$19,090	$19,091 - $28,635	$28,636 - $47,725
4	$23,050	$23,051 - $34,575	$34,576 - $57,625
5	$27,010	$27,011 - $40,515	$40,516 - $67,525
6	$30,970	$30,971 - $46,455	$46,456 - $77,425
7	$34,930	$34,931 - $52,395	$52,396 - $87,325
8	$38,890	$38,891 - $58,335	$58,336 - $97,225

For families with more than eight persons, add $3,960 for each additional person to calculate the low copay level.
Rates effective as of 3/1/12.