How pharmacy coverage works
Both health plans offer prescription medication coverage. How you pay and how much you pay for your prescriptions depends on a couple things:
The medical plan you choose will determine how much you pay for prescription medications:
HSA Advantage Plan Signature Plan Uses primarily coinsurance: You pay 100% of the Uses primarily set copay amounts, regardless The coinsurance percentage is the same for all The higher the medication tier, the higher the copay. Your coinsurance and the price of most medications, is lowest with the health system pharmacy. Copays are lowest with the health system pharmacy. If you use a pharmacy that is out-of-network: Pay 50% coinsurance after you meet your separate out-of-network deductible. If you use a pharmacy that is out-of-network: Pay 50% coinsurance after you meet your separate out-of-network deductible.
cost until your deductible is met, then a percentage until you reach your out-of-pocket maximum.
of whether your deductible has been met.
medication cost tiers, but a drug in a higher-cost
tier means you’ll likely pay more out-of-pocket.
Resources
- 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.
- Learn more about how the formulary works and impacts the amount you pay for your medication.
The type of medication you’re prescribed and where you fill:
Prescriptions fall into three general medication types that determine where you can fill the prescription and how many days’ supply you can receive. For the best service and most cost-effective options for your medications, use the health system pharmacy.
- Acute medications are prescribed to treat short-term symptoms for a specified period of time (antibiotics, antivirals, steroids, etc.). Learn more about acute medication coverage.
Where to fill:
- Health system pharmacy
- Medical Park pharmacy in Great Bend for the health system rate
- In-network pharmacy
- Maintenance medications are prescribed for long-term, regular use to treat a chronic health condition (asthma, diabetes, high blood pressure, etc.). Learn more about maintenance medication coverage.
Where to fill:
- Health system pharmacy
Other considerations:
- Must be for at least a 90-day supply (as allowed by state/federal laws)
- Must be delivered for free (pharmacy pick-up not available)
- Specialty medications are prescribed to treat chronic complex health conditions. Learn more about specialty medication coverage.
Where to fill:
- Health system pharmacy