PROVIDENCE — The state’s plan to hit Medicaid recipients with prescription drug copayments, starting in October, has provoked alarm from people on all sides of the issue — pharmacists and advocates for the elderly, poor and disabled.

The new copays — $1 for each generic prescription, $3 for each brand-name drug — will apply to about 14,000 people in the Medicaid fee-for-service program, mostly people with disabilities and very poor elderly.

The General Assembly approved the copays last year, but they weren’t implemented because of a court decision that required the passage of additional legislation. Advocates have said all along that the copays constitute an extra cost for those who can least afford to pay.

But if the state is going to charge the copays, they say, the least it can do is publicize a federal law that allows Medicaid recipients who can’t afford a copay to continue getting their prescriptions for free.

That exception isn’t mentioned in draft state regulations that describe the new copays. Advocates are asking the state to rewrite the rules to include it. Otherwise, “we’re worried that people won’t know about it,” says Jessica Buhler, director of the Senior Agenda Coalition.

They are also asking for a hearing on the new regulations, and Jane Hayward, the state secretary of the Department of Health and Human Services, said yesterday that the state is “always happy to respond to a hearing request,” and will in this case.

John Young, associate director of the state DHS, said the state has refrained from publicizing the exception on purpose, because it does not plan to compensate pharmacies for the money they lose when people claim inability to pay.

The copays are budgeted to save the state $1.3 million — including $600,000 in state general revenue — this fiscal year. If pharmacies don’t collect the copays and pass the money along to the state, “you can’t achieve that savings,” Young says.

Pharmacists, too, are worried about what will happen if too many people plead indigence.

It costs a pharmacy $10 to dispense the average prescription, a figure that incorporates staffing and overhead costs — “the whole nine yards,” says Jack Hutson, executive director of the Rhode Island Pharmacists’ Association. But the state only pays pharmacies a $3.40 dispensing fee for each Medicaid prescription, meaning pharmacies are already losing money on Medicaid.

If they are expected to collect a $3 copay, and have to reimburse the state for the copay whether they actually collect it or not, then in some cases they will essentially be giving the drugs away for free, getting no compensation for the goods or the service the pharmacy provides, Hutson says.

One state lawmaker — Sen. Leo R. Blais, R-Coventry — will see the new policy’s effects personally: He owns the Pawtuxet Valley Prescription Center in Coventry. Blais says the new policy amounts to “another tax on pharmacies to support the budget of the Department of Human Services.”

In charging copays for this program, Rhode Island is not a leader among states: More than 40 already do, according to the federal Center for Medicare and Medicaid Services.

But when Massachusetts started charging copays, many pharmacies stopped accepting Medicaid, says David Feeney, the owner of Oxnard Pharmacy in Warwick. He predicts pharmacies in Rhode Island would do the same.

“You can’t do business and lose money,” Feeney says.

The copays will affect people like Bob and Eileen Rouleau, Johnston residents who are both disabled. Bob Rouleau is 57 and his wife is 54; they receive less than $1,500 a month in disability payments and $53 a month for food stamps. It is their only income.

Rouleau said he takes medications for diabetes, hypertension and a heart condition — nine prescriptions in all — and that his wife has two prescriptions.

“They passed a law without even thinking of people’s income,” Rouleau says. He says he will probably take advantage of the option to claim inability to pay.

Richard Backer, owner of the East Side Prescription Center in Providence, wouldn’t blame him, even though such decisions hurt pharmacies.

“If people are on Medicaid to begin with, doesn’t that mean they’re poor?” he asks. “Where are they supposed to get the money from? This just doesn’t seem to make any sense.”

egudrais@projo.com