How pharmacy coverage works

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

The medical plan you choose

Both medical plans include prescription medication coverage. The premiums for the plans are different see those costs here.


Signature Plan

HSA Advantage Plan

Is the formulary (list of covered medications) the same?

Yes

Yes

Is there a deductible?

No

Yes, you pay 100% of the cost until your deductible (for medical and pharmacy) is met

Can a copay card be used?

Yes. Please note, copay card amounts used for specialty and many high-cost medications will not apply to your maximum out of pocket

Yes. Please note, copay cards for specialty and many high-cost brand medications cannot be used until you have met the deductible, and these amounts will not apply to your maximum out of pocket

How are medications paid for?

Primarily uses set copay amounts, regardless of whether your deductible has been met

Primarily uses coinsurance: You pay 100% of the cost until your deductible is met, then a percentage of the cost until you reach your out-of-pocket maximum

Do different medications cost different prices? 

Yes, the higher the medication tier on the formulary, the higher the copay

The coinsurance percentage is the same for all tiers of medication, however, a drug in a higher-cost tier, such as a tier 4, means you’ll likely pay more out-of-pocket

Are prior authorizations required?*

Yes

Yes

*Prior authorizations help ensure medications are safe, appropriate and used at the right time. This process ensures all necessary labs have been checked, patients have the correct diagnoses and that first-line treatments have been tried.

The type of medication you’re prescribed and where you fill it

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

Medication Type

What they are

Where to fill

Treat short-term symptoms for a specified period of time (antibiotics, antivirals, steroids, etc.)

  • Health system pharmacy

  • Medical Park pharmacy in Great Bend for the health system rate

  • In-network pharmacy

  • Pick-up or free delivery

Use the health system pharmacy for the best cost!

Treat long-term, chronic conditions (asthma, diabetes, high blood pressure, etc.)

  • Health system pharmacy

  • Must be for at least a 90-day supply (as allowed by state/federal laws)

  • Free delivery only

  • Controlled substances may be picked up at any health system location

Treat complex, chronic health conditions (Crohn’s disease, cancer, cystic fibrosis, etc.)

  • Health system pharmacy

  • Pick up or free delivery

The medication tier

The prescription drug formulary classifies non-specialty medications by four cost tiers, with tier 1 being the least expensive and tier 4 being the most expensive. Specialty medications are listed by 3 tiers, with tier 1 again being the least expensive.

  • Find your medication tier on the formulary using this guide.
  • To help manage your prescription costs, always ask your provider for a medication in tier 1, if available, for the lowest cost.

Signature Plan members

  • The higher the medication tier on the formulary, the higher the copay.

HSA Advantage Plan members

  • The coinsurance percentage is the same for all medication tiers, including specialty medications, but a drug in a higher-cost tier means you’ll likely pay more out of pocket. If you’re using one on the preventive medication list, you’ll pay the Signature Plan copay, which is typically lower than the deductible plus coinsurance.

Resources

Pharmacy Resource Guide