Prescription coverage is provided as part of both medical plans.
New in 2023: Navitus Health Solutions will be the new pharmacy benefits manager (PBM) for the health system.
If you sign up for coverage from a health system medical plan, you will receive communications from Navitus by mail and/or email. This will include a new pharmacy ID card that is separate from your medical ID card, information on how to use the Navitus mobile app and website, and information about medication changes, if applicable.
For tips to manage prescription costs, read Tips to make the most of your pharmacy benefit.
How much you pay for your prescriptions depends on these factors:
- The medical plan you choose
- The type of medication you are prescribed
- The pharmacy where you fill the prescription
- How many days’ supply you receive
What will I pay for a prescription under each medical plan?
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. The chart below shows how much of the cost of prescriptions you will pay under each medical plan.
If you choose the HSA Advantage Plan, you will pay the full cost of a prescription until you reach your deductible, then you’ll pay a percentage of the cost (called coinsurance) until you reach your maximum out-of-pocket cost. The cost will vary based on the type of medication, the pharmacy you choose, and how many days’ supply you receive.
Some types of medications are included in an extended preventive drug list. For members of the HSA Advantage Plan, medications on this list only will follow copays for the Signature Plan listed in the chart below. To know the copay amount, find the medication on the formulary (see How to Read Your Formulary) and note what tier it is listed under. Then look on the chart below to find that tier and the copay amount. These copay amounts will not apply to the deductible for the HSA Advantage Plan, but will apply to the out-of-pocket maximum.
If you choose the Signature Plan, you will pay a copay of $5 to $200 depending on the type of medication, the pharmacy you choose, and how many days’ supply you receive.
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 | ||
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 (SP or LD) | Up to a 30- DAY SUPPLY | Not covered | Up to a 30- DAY SUPPLY | Not covered | ||
Generic/tier 1 | Deductible +10% coinsurance | $20 copay | ||||
Preferred brand/tier 2** | $100 copay | |||||
Nonpreferred brand/tier 3** | $200 copay | |||||
* You can search for in-network pharmacies at KansasHealthSystemBenefits.com.
** Choosing a brand when a generic is available will result in higher cost.
What type of medication am I getting?
Prescription drugs fall into three categories that help determine what they will cost and where you can fill them.
- Acute medication – medication prescribed to treat short-term symptoms for a specified period of time
- Maintenance medication – medication requiring long-term, regular use to treat a chronic health condition
- Specialty medication – high-cost medications used to treat a chronic or complex health condition
The Navitus formulary also ranks medications into formulary tiers. The formulary will help you determine whether your medication is tier 1 (generic), tier 2 (preferred brand), or tier 3 (nonpreferred brand).
Sometimes, you have a choice between generic or brand name medications, or among different types of brand-name medications. To save money, you may want to talk to your prescriber about switching to a generic or preferred brand medication for your condition.
Specialty medications also have tiers have tiers that determine the cost difference. Learn how to read a drug formulary.
- Tier 1 (SP or LD generic)
- Tier 2 (SP or LD preferred brand)
- Tier 3 (SP or LD nonpreferred brand)
Where should I fill my prescription?
The health system pharmacy should be your first choice. The health system pharmacy provides the best price and offers convenient home delivery.
To help manage costs, the health system pharmacy is the only place you can get maintenance and specialty medications filled.
You can also save money on prescriptions for acute needs by getting them at the health system pharmacy, which has the lowest copay and coinsurance. For Great Bend, the Medical Park Pharmacy also offers the most cost-effective option for your acute medication needs.
There is no need to visit the health system pharmacy in person. You can fill new and existing prescriptions electronically and get free home delivery. To transfer a prescription to a health system pharmacy, follow these steps.
If you are prescribed acute medications for short-term symptoms, you can go to any in-network pharmacy, but you’ll pay more (either a higher copay or higher coinsurance) than you would at a health system pharmacy.
You can search for other in-network pharmacies here.
Southlake | The University of Kansas Health System, Bell Hospital | The University of Kansas Hospital, Indian Creek Campus | The University of Kansas Hospital, Cambridge Tower A | Westwood Medical Pavilion |
11300 Corporate Ave. Lenexa, KS 66219 | 4000 Cambridge St. Kansas City, KS 66160 | 10710 Nall Ave. Overland Park, KS 66211 | 3825 Cambridge St. Kansas City, KS 66160 | 2650 Shawnee Mission Pkwy. Westwood, KS 66205 |
913-574-0600 | 913-588-2361 | 913-574-4805 | 913-574-3100 | 913-945-7700 |
How many days’ supply should I request?
If you choose the Signature Plan as your medical plan, you can save money on your acute and maintenance medications by asking your provider to prescribe a 90-day supply. You can receive 3 times the supply for only twice the copay of a 30-day supply.
