What do I pay for my prescription drugs?
The amount you pay will depend on several important factors: which medical plan you choose, where you fill your prescription, the type of medication and the day supply.
The health system pharmacy provides the best price and is the most convenient. You can fill new and existing prescriptions electronically (see page 24) and have your prescriptions delivered to your home free of charge.
To help you and the health system manage costs, the health system pharmacy is the exclusive provider of maintenance and specialty medications. Below is a summary of employee cost for each medical plan and different pharmacies (health system or an in-network location).
| HSA Advantage Plan^ | Signature Plan | |||||
|---|---|---|---|---|---|---|
| Health system pharmacy | In-network pharmacy* | Health system pharmacy | In-network pharmacy* | |||
| Acute (short-term) prescriptions | Up to a102-DAY SUPPLY | Up to a102-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 | Deductible +10% coinsurance | Deductible +30% coinsurance | $5 copay | $10 copay | $25 copay | $50 copay |
| Preferred brand/tier 2** | $30 copay | $60 copay | $55 copay | $110 copay | ||
| Nonpreferred brand/tier 3** | $65 copay | $130 copay | $90 copay | $180 copay | ||
| Maintenance prescriptions | Up to a102-DAY SUPPLY | Not covered | Up to a 34-DAY SUPPLY | 35-102-DAY SUPPLY | Not covered | |
| Generic/tier 1 | Deductible +10% coinsurance | $5 copay | $10 copay | |||
| Preferred brand/tier 2** | $30 copay | $60 copay | ||||
| Nonpreferred brand/tier 3** | $65 copay | $130 copay | ||||
| Specialty prescriptions | Up to a 34-DAY SUPPLY | Not covered | Up to a 34-DAY SUPPLY | Not Covered | ||
| Generic/tier 4 | Deductible +10% coinsurance | $20 copay | ||||
| Preferred brand/tier 5** | $100 copay | |||||
| Nonpreferred brand/tier 6** | $200 copay | |||||
^ Certain preventive medications are covered at the same copays as under the Signature Plan.
** Choosing a brand when a generic is available will result in higher cost.
* You can search for in-network pharmacies at myhealthtoolkitkc.com.
What type of prescription do you have?
Acute – medications prescribed to treat short-term symptoms for a specified period of time
Maintenance – medications requiring long-term, regular use to treat a chronic health condition
Specialty – high-cost medications used to treat a chronic or complex health condition.
