Pharmacy

In-Network Pharmacies

Kaiser Permanente Pharmacies in Georgia & Network Pharmacies

Kaiser Permanente Pharmacies in Georgia

Prescriptions through Kaiser Permanente Pharmacies in Georgia.

You can fill prescriptions (written by any provider) at pharmacies located in Kaiser Permanente medical offices in Georgia. You will pay the lowest out-of-pocket costs at these pharmacies. Choose how to fill your prescriptions:

• At Kaiser Permanente medical offices in Georgia. Most Kaiser Permanente medical offices in Georgia across the region have pharmacies. Kaiser Permanente doctors in Georgia can send most prescriptions electronically to the pharmacy—or you can present your prescription with your ID card.
• Online. Register at kp.org/register to order most refills online and have the medicine mailed to you.
• Through the Refill phone line. Call us at 1-800-733-6345   , 24 hours a day, and have the medicine mailed to you or available for pick up at any medical office.*

For medication listed as a specialty drug on our formulary, you’ll have the lowest specialty drug out-of-pocket cost at a Kaiser Permanente Pharmacy. You can also a choose a Specialty Network Pharmacy but  your out-of-pocket costs will likely be higher than a Kaiser Permanente Pharmacy.

* A program operated or arranged by a health plan that distributes prescription drugs to members via mail. Some medications are not eligible for the Mail Service Delivery Program. These may include, but are not limited to, drugs that are time or temperature sensitive, drugs that cannot legally be sent by U.S. mail, and drugs that require professional administration or observation.

Precertification of Outpatient Prescription Drugs (for certain drugs, step therapies, age, and quantity limits for Network Pharmacies):

Members will need to get precertification for certain outpatient prescription drugs. We’ve partnered with MedImpact to help ensure that outpatient prescription drugs ordered by your doctor are medically necessary, cost-effective, and the most appropriate treatment for your condition. Before you receive certain outpatient prescription drugs, your physician should request precertification by calling MedImpact. MedImpact will facilitate the precertification process with the physician. MedImpact can be reached at 1-800-788-2949 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Mountain time.

Search the directory to Find Kaiser Permanente Pharmacies in Georgia where you’d like to pick up your prescription.

Network Pharmacies

Prescriptions through Network retail pharmacies.

• You can fill prescriptions (written by any provider) at Network Pharmacies.
• You can use any of the retail pharmacies nationwide that participate in the MedImpact pharmacy network.

You can fill prescriptions at any participating Network Pharmacy. Here’s a partial list:

• Costco
• Rite Aid
• Walgreens
• Publix
• Kroger
• Target
• Safeway

Not all locations in a chain participate; some are independently contracted. To check on a specific pharmacy or for more information, call Customer Service at 1-855-364-3185 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Eastern time, or Find MedImpact Pharmacies. Live or traveling outside of Georgia, Find MedImpact Pharmacies.

Precertification of Outpatient Prescription Drugs (for certain drugs, step therapies, age, and quantity limits for Network Pharmacies):

Members will need to get precertification for certain outpatient prescription drugs. We’ve partnered with MedImpact to help ensure that outpatient prescription drugs ordered by your doctor are medically necessary, cost-effective, and the most appropriate treatment for your condition. Before you receive certain outpatient prescription drugs, your physician should request precertification by calling MedImpact. MedImpact will facilitate the precertification process with the physician. MedImpact can be reached at 1-800-788-2949 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Mountain time.

Find out what drugs are covered.

Access the Dual Choice PPO Prescription Drug Formulary 2024.

What you pay for covered drugs is determined by the outpatient prescription drug benefit outlined in your Evidence of Coverage. Open formulary benefits have a generic cost sharing requirement. This means that if you fill a brand name drug when a generic is available, that in addition to your standard copayment or coinsurance, you will also pay the difference in cost between the brand name and generic drug.

Tier Level and Description:

Tier 1: Preventative generics, covered at the lowest cost share amount

Tier 2: Preferred generics covered at the second lowest cost share amount

Tier 3: Preferred Brand, covered at your Preferred Brand cost share amount

Tier 4: Non-preferred drugs

Tier 5: Specialty medications

Access the Drug Reimbursement Form

Pharmacy Claims Address:
MedImpact Healthcare Systems, Inc.
PO Box 509098
San Diego, CA 92150-9098

In the event you get your drugs from an Out of Network Pharmacy and are asked to pay the full amount, you can use the Drug Reimbursement Form for reimbursement.

Expected pharmacy review turnaround times for prescriptions that require prior authorization:

Urgent Requests: 24 hours
Standard Requests: 48 hours

What if my pharmacy claim is denied?

If we have denied coverage for certain prescription drugs, in whole or in part, then you may request that we review this decision, also referred to as an “adverse benefit determination.”

You, or a representative whom you formally appoint in writing, have the right to appeal our decision by asking that we review it.  To appeal the decision, please send your request for review in writing, to:

 KPIC Pharmacy Administrator
Grievance & Appeals Coordinator 
10181 Scripps Gateway Court 
San Diego, CA 92131
(800) 788-2949

Or you can fax the letter to (858) 790-6060, Attn: KPIC Pharmacy Administrator Grievance and Appeals Coordinator.

In your request, please include:

(1) your name and, your medical record number
(2) your medical condition or symptom
(3) the specific prescription drug or supply that you are requesting, and
(4) the specific reason(s) for your request that we review our initial decision.

We must receive your request within 180 days of your receiving the notice of our adverse benefit determination.  Please note that we will count the 180 days starting 5 business days from the date of the notice to allow for mail delivery time, unless you can prove that you received the notice after that 5 business day period.

A decision about your appeal will be made within 30 days of receipt of your request for review at each level unless we inform you otherwise in advance.

If you disagree with our decision on your first level appeal, your first level appeal adverse decision notice will tell you how to submit a second level appeal.

Appointment of a Representative

If you would like to have someone act on your behalf during our review, you may appoint an authorized representative.  You must make this appointment in writing.  Please send the name, address and telephone contact information to KPIC Pharmacy Administrator Grievance and Appeals Coordinator at the address set forth above.

If you want to review the information that we have collected regarding your claim for this service, you may request, and we will provide without charge, copies of all relevant documents, records, and other information.

You may send us additional information including comments, documents, or additional medical records which you believe supports your claim.  If we had asked for additional information before and you did not provide it, we would still like to have that additional information for our review.  Please send all your additional information to:

KPIC Pharmacy Administrator
Grievance & Appeals Coordinator
10181 Scripps Gateway Court 
San Diego, CA 92131
(800) 788-2949

Or you can fax the letter to (858) 790-6060 Attn: KPIC Pharmacy Administrator Grievance and Appeals Coordinator

In addition, you may give testimony in writing or by telephone.  Please send your written testimony to KPIC Pharmacy Administrator Grievance and Appeals Coordinator at the address set forth above.  To arrange to give testimony by telephone, you should contact KPIC Pharmacy Administrator Grievance & Appeals Coordinator at the telephone number above. We will add all of the new information to your claim file and we will review it without regard to whether this information was submitted and/or considered in our initial decision.

We will share any additional information that we collect in the course of our review by sending it to you in advance of our decision.   If we believe on review that your request should not be granted, before we issue our final decision, we will also share with you in writing any new or additional reasons for that decision.  We will send you a letter explaining the new or additional information and/or reasons.  Our notices will tell you how you can respond to the information provided if you choose to do so.  If you do not respond before we must make our final decision, that decision will be based on the information already in your claim file.

Should you have any questions regarding your appeal rights, please contact KPIC Pharmacy Administrator Grievance and Appeals Coordinator at (800) 788-2949.

For more information, refer to your Certificate of Insurance (COI) or call Customer Service for assistance at 1-855-364-3185 (TTY 711).