Prescription medication coverage - The University of Kansas Health System Benefits Portal

Both health system medical plans include prescription medication coverage.

Navitus Health Solutions is the health system’s pharmacy benefits manager (PBM). When you sign up for a health system medical plan, you will receive a pharmacy ID card (separate from your medical ID card) and instructions on how to use the Navitus member portal and mobile app.

Navitus will also keep you informed about your medications through the Navitus member website and mobile app.

Download from Apple App Store
Download from Google Play
Use the information on your pharmacy ID card to get started.

To manage your health system pharmacy prescriptions, use MyChart website and mobile app.

Download from Apple App Store
Download from Google Play
Click “Sign Up Now” to get started.

What will I pay for my prescriptions?

How you pay and how much you pay for your prescriptions depends on several things:

The medical plan you choose will determine if you pay a set copay or deductible/coinsurance.
For the Signature Plan, the tier of the medication and other factors for drugs covered on the health plan’s prescription drug formulary.
The type of medication and who prescribed it will determine where you can fill the prescription and how many days’ supply you can receive.

The medical plan you choose

The medical plan you choose will impact how much you pay for your medications. It is important to review the medications you are currently taking to see which plan best fits your needs.

Signature Plan: If you choose the Signature Plan, you will primarily pay set copays of $5 to $200 depending on the medication you are prescribed, the pharmacy you choose and how many days’ supply you receive.

HSA Advantage Plan: If you choose the HSA Advantage Plan, you will primarily pay coinsurance, or a percentage of the cost, for your medications. Here’s how it works: you pay the full cost of prescriptions until you reach your annual deductible. After that, you pay coinsurance of 10-30% until you reach your out-of-pocket maximum.

Learn more about deductibles, copays, coinsurance and out-of-pocket maximums in our guide to understanding how you and the health system share the cost for your healthcare expenses.

Cost tiers: The formulary

The medications covered are the same in both the HSA Advantage and Signature plans. You will find a list of the medications covered on the prescription drug formulary provided by Navitus.

Below is a brief overview of how to use the formulary; for a deeper dive, see “How to read your prescription drug formulary.” It’s a good idea to make a list of your drugs and compare it to the formulary when choosing your medical plan. Then, consider how the copay or deductible plus coinsurance models described above will impact your share of the cost.

For the Signature Plan, one way the prescription drug formulary classifies medications is by cost tier – usually 1, 2, or 3 – to indicate whether a medication is generic, preferred brand or nonpreferred brand.

Generic medications (Tier 1)are the most cost-effective option for many prescriptions. Generic drugs must work in the same way and provide the same clinical benefit as their brand-name counterparts to be approved by the Food and Drug Administration (FDA).
Preferred brand medications (Tier 2) are brand-name medications that are favored over other brand-name medications on the formulary. Choosing a preferred brand when a generic is available will result in higher cost. You may want to talk to your provider to determine if switching to a generic medication can save you money.
Nonpreferred brand medications (Tier 3)are the highest cost option for covered prescriptions on the formulary. Choosing a nonpreferred brand when a generic or preferred brand is available will result in higher cost. You may want to talk to your provider to determine if switching to a generic or preferred brand medication can save you money.

With the Signature Plan, both medication type and cost tier will affect the amount of your copay. For example, a 30-day supply of a generic, tier 1 maintenance prescription would be a $5 copay while a 30-day supply of a generic, tier 1 specialty prescription would be a $20 copay.

With the HSA Advantage Plan, the percentage of coinsurance doesn’t change based on medication type or cost tier but does change based on where you fill your prescription.

For example, an antibiotic at the health system pharmacy will be a 10% coinsurance after you have met your deductible, but that same antibiotic will be a 30% coinsurance at an in-network pharmacy such as Walgreens or Walmart.

In addition, there can be a big difference in the overall cost of the drug based on whether you choose lower-cost generics or higher-cost brand-name drugs, which will make the amount of your coinsurance higher.

Learn more about cost tiers and special codes in our guide on how to read your prescription drug formulary.

The type of medication you are prescribed

Prescriptions fall into three general medication types that determine where you can fill the prescription and how many days’ supply you can receive.

Acute medications are prescribed to treat short-term symptoms for a specified period of time (antibiotics, antivirals, steroids, etc.).
Maintenance medications are prescribed for long-term, regular use to treat a chronic health condition (asthma, diabetes, high blood pressure, etc.).
Specialty medications are prescribed to treat complex health conditions.

The sections below describe each medication type in more detail and explain where you can fill prescriptions for that type of medication and how many days’ supply you may receive.

Acute medications

Prescriptions for acute medications, used to treat short-term symptoms, may be filled by the health system pharmacy or any in-network pharmacy and will be covered according to the chart below.

For the best rate, use the health system pharmacy, with convenient locations available for pickup. For pickup,please have your provider send the prescription to the Bell Hospital Tower, Indian Creek Retail Pharmacy, Cambridge Tower A, or Westwood Medical Pavilion location. Prescriptions are often available for pickup the same day they are received.
- The health system rate is also honored (for acute medications only) at the Medical Park Pharmacy in Great Bend (1309 Polk St., Great Bend, KS, 67530, 620-792-1221).
You may also fill acute medications at any in-network pharmacy. While the cost is higher, the network may offer a more convenient location to pick up a medication when you need it quickly. Search for in-network pharmacies on the Navitus pharmacy network list, the Navitus member portal or the Navitus mobile app (Apple App Store / Google Play).
- AuBurn pharmacies are available for acute medications at the in-network rate.

	HSA Advantage Plan		Signature Plan
Medication type	Health system pharmacy	In-network phamacy**	Health system pharmacy		In-network pharmacy**
Acute prescriptions	Up to a 102 DAY SUPPLY	Up to a 102 DAY SUPPLY	Up to a 34 DAY SUPPLY	35-102 DAY SUPPLY	Up to a 34 DAY SUPPLY	35-102 DAY SUPPLY
Generic / Tier 1	10% (after deductible)^^	30% (after deductible)^^	$5	$10	$25	$50
Preferred brand / Tier 2			$30	$60	$55	$110
Nonpreferred brand / Tier 3			$65	$130	$90	$180
Certain medications used for chronic conditions or risk reduction are included in the preventive drug list. HSA Advantage Plan members will pay Signature Plan copays for medications on this list. These copays will not apply to the HSA Advantage Plan deductible but will apply to the out-of-pocket maximum. * While the health system pharmacy should be your first choice for prescriptions, many pharmacies throughout the nation participate in the pharmacy network. ^^ HSA Advantage Plan members will pay 100% until their deductible is met, then pay the indicated percentage coinsurance until their out-of-pocket maximum is reached.

Maintenance medications

Maintenance medications, those used to treat chronic health conditions, must be filled by the health system pharmacy to receive coverage. If you fill a maintenance medication outside the health system pharmacy, including an in-network pharmacy, you will pay the full cost of the medication. This amount will not apply toward your deductible or out-of-pocket maximum.

To see if your medication falls into this category, please review the maintenance drug list.

Olathe Health employees have until May 31, 2024, to transition prescriptions to the health system pharmacy. Beginning June 1 2024, maintenance medications filled outside the health system pharmacy will not be covered. For the lowest rate, start using the health system pharmacy right away. Information about how to fill your prescriptions with the health system pharmacy will be provided in fall 2023.

Some maintenance medications used for chronic conditions or to lower the risk of developing a chronic condition are included on the list of preventive drugs. If you are on the HSA Advantage Plan, you pay the copay listed for the Signature Plan for medications on the preventive drug list, which is typically lower than the deductible plus coinsurance.

Signature Plan members can fill a three-month supply of their medications, when applicable, for the same cost as two months. Save by asking your provider to issue prescriptions for a 90-day supply.

	HSA Advantage Plan		Signature Plan
Medication type	Health system pharmacy	In-network phamacy**	Health system pharmacy		In-network pharmacy**
Maintenance prescriptions	Up to a 102 DAY SUPPLY	Maintenance prescriptions NOT COVERED at in-network pharmacies	Up to a 34 DAY SUPPLY	35-102 DAY SUPPLY	Maintenance prescriptions NOT COVERED at in-network pharmacies
Generic / Tier 1	10% (after deductible)^^		$5	$10
Preferred brand / Tier 2			$30	$60
Nonpreferred brand / Tier 3			$65	$130
*Certain medications used for chronic conditions or risk reduction are included in the preventive drug list. HSA Advantage Plan members will pay Signature Plan copays for medications on this list. These copays will not apply to the HSA Advantage Plan deductible but will apply to the out-of-pocket maximum. ^^ HSA Advantage Plan members will pay 100% until their deductible is met, then pay the indicated percentage coinsurance until their out-of-pocket maximum is reached.

About the free prescription delivery service

The health system pharmacy provides free delivery service for your prescriptions. Prescriptions can be delivered to your home, another preferred address (but not at work), or a FedEx hold-at/pickup location. For delivery, have your provider send the prescription to the Southlake location. Beginning June 1, 2024, free delivery of maintenance medications from the health system pharmacy will be required.

If you haven’t used the health system pharmacy’s free delivery service before, a pharmacist will call to confirm the delivery address, your email address (for shipping updates), and your payment method (for your deductible plus coinsurance or copay). Then, your medication will arrive via FedEx within 3 business days.

If you don’t want medications delivered to your home, you can use a FedEx hold-at/pickup location. Designate your preferred location and the health system pharmacy will deliver your medications there. FedEx will sign for your prescriptions and hold them in a safe location for you to pick up within 7 days. Indicate your preferred FedEx hold-at/pickup location when the pharmacist calls to confirm your prescription details or email MyRPh@kumc.edu to make FedEx arrangements.

About prescription pickup

Through May 31, 2024, you may also pick up your maintenance prescriptions with the health system pharmacy.

Ask your provider to submit the prescription to Bell Hospital Tower, Indian Creek Retail Pharmacy, Cambridge Tower A, or Westwood Medical Pavilion. Please note that Southlake does not have a waiting area, so pickups are easier at other health system pharmacy locations.

Important changes coming June 1, 2024

Beginning June 1, 2024, two important changes will affect coverage for maintenance medications:

All maintenance medications must be filled for a 90-day supply. To prepare for this change, when your provider writes new prescriptions for your maintenance medications, ask for a 90-day supply.

Maintenance medications must be delivered from the health system pharmacy to your preferred address (not a work address). You may have your prescriptions sent to your home, another preferred address or a FedEx hold-at/pickup location at no additional cost. More details about these changes will be communicated in the spring.

Specialty medications

Specialty medications, for complex health conditions, must be filled by a specialty pharmacy. To see if your medication falls into this category, look for MSP or LDD on the prescription drug formulary in the column labeled “Special Code.”

Specialty medications may be filled for a maximum of 30 days.

Beginning January 1, 2024, which specialty pharmacy you use will depend on who prescribes your specialty medication.

If the prescription is written by a provider at The University of Kansas Health System (excluding Olathe Health), the employee/dependent must use the health system pharmacy.
If the prescription is written by a provider at Olathe Health or outside the health system, the employee/dependent must use the Navitus preferred specialty pharmacy.
- Instructions for this process will be provided later this year.

	HSA Advantage Plan	Signature Plan
Medication Type	All medications must be filled by the health system pharmacy or Navitus preferred specialty pharmacy depending on the prescriber.
Specialty prescriptions	Up to a 30 DAY SUPPLY	Up to a 30 DAY SUPPLY
Generic / Tier 1	10% (after deductible)^^	$20
Preferred brand / Tier 2		$100
Nonpreferred brand / Tier 3		$200
^^ HSA Advantage Plan members will pay 100% until their deductible is met, then pay the indicated percentage coinsurance until their out-of-pocket maximum is reached.

For more information on managing prescription costs, read our tips to make the most of your pharmacy benefit.