Make your pharmacy benefit work for you
Are prescription benefits a mystery to you? If so, you’re not alone.
Where you fill your prescriptions, whether you choose generic or brand, the days’ supply, even your medical plan can all have an impact on how much you’ll pay when you have a prescription filled.
You can avoid frustration and stay within budget with this helpful guide. Let’s take it step-by-step.
1. The medical plan you choose
The two medical plans available through The University of Kansas Health System offer different types of prescription coverage.
- HSA Advantage Plan: you’ll pay the full cost of prescriptions until you reach your deductible. Once you reach your deductible, you will pay a percentage of the cost of the prescription (coinsurance). You can pay using pretax dollars from your HSA account, including the health system’s seed money, to pay these costs.
- Signature Plan: you’ll pay a traditional copay.
2. The kind of prescription you need
The type of prescription you’re filling dictates where you can fill and how much you’ll pay.
- Acute: medications that treat short-term symptoms for a specified period of time. Can be filled at a health system pharmacy or at another in-network pharmacy.
- Maintenance: medications requiring long-term, regular use to treat a chronic health condition. Can only be filled from a health system pharmacy.
- Specialty: high-cost medications used to treat a chronic or complex health condition. Can only be filled at a health system pharmacy.
3. Brand vs. generic
Check your plan formulary. Generic medications (tier 1 or 4 on the formulary list) are your lowest-cost option. If a generic is available and you choose a preferred brand-name medication (tier 2 or 5), you’ll pay more. In all cases, if you choose a brand-name medication that is nonpreferred (tier 3 or 6), your cost will be even higher.
4. The pharmacy you use
You should always use the health system pharmacy for the best price. Maintenance and specialty medications must be filled via the health system pharmacy, and you’ll often pay less when you fill acute medications there too. There’s no need to visit a health system pharmacy in person: you can fill, refill and transfer medications electronically or by phone and get fast, free home delivery.
For details about how to use the health system pharmacy, see page 28 of the interactive benefits guide. To find an in-network pharmacy, visit myhealthtoolkitkc.com. Click Education Center > Enrollment Tools > Pharmacy Locator.
5. Days’ supply
On the Signature Plan, you can save more when you get more for most medications. You can get up to three times the supply for two times the copay at the health system pharmacy when your provider writes for a three-month supply.
Bringing it all together
To see your options in detail, visit review the pharmacy chart in the interactive benefits guide .