Pharmacy
Prescription coverage is part of your KP Plus plan. Where you choose to have your prescriptions filled will determine how much you pay for your medications. Your pharmacy options include Kaiser Permanente and affiliated pharmacies in Georgia, as well as out-of-network pharmacies. You can choose any pharmacy option regardless of the prescribing provider.
Kaiser Permanente Pharmacies
Prescriptions through Kaiser Permanente and affiliated pharmacies
You can fill prescriptions (written by any provider) at pharmacies located in Kaiser Permanente medical centers. You will generally pay the lowest out-of-pocket costs at these pharmacies. Choose how to fill your prescriptions:
- At Kaiser Permanente medical centers. Most Kaiser Permanente medical centers have pharmacies. When you get care at a Kaiser Permanente location, you can usually pick up prescriptions your doctor writes before you even leave the building. You can also come in to fill prescriptions written by out-of-network doctors.
- Online. Register at kp.org/register to order most refills online and have them mailed to you with no cost for shipping.
- Through the refill phone line.1-800-733-6345 (TTY 711), 24 hours a day, and have the medication mailed to you or available for pick up at any medical center.*
When filling a prescription at a Kaiser Permanente pharmacy, the information will become part of your Kaiser Permanente medical record for better-coordinated care. If you present a prescription from an out-of-network provider for a drug that is not on the Kaiser Permanente formulary, the Kaiser Permanente pharmacist will likely check with the prescribing physician to determine if a therapeutic equivalent from the Kaiser Permanente formulary can be substituted.
To find your nearest Kaiser Permanente pharmacy, visit kp.org/facilities.
If you’re not near a Kaiser Permanente facility, you also have the option to get your initial prescription filled at one of our affiliated pharmacies like Walgreens (usually at a higher copay).
*A program operated or arranged by 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.
Out-of-Network Pharmacies
- You have 5 fills within any licensed out-of-network pharmacy each contract year, up to a 30-day supply per fill.
- An out-of-network fill is any prescription service that is received out-of-network. Multiple prescriptions in the same pharmacy visit on the same day will count as multiple fills and will each count towards the annual limit.
- For example, filling a prescription for all of the following will count toward 3 of the 5 fill limits: 1 antibiotic prescription, 1 flu shot, and 1 eye drop prescription.
- You may need to pay for prescriptions filled at out-of-network pharmacies in full, and then submit a claim for reimbursement.
- Send your receipt and copy of the portion of the prescription label that contains the drug name/prescription information to the address below for reimbursement. Once we receive the documentation, if your drug is covered, you’ll be reimbursed for the cost of the drug, minus your out-of-network benefit cost share.
- You will likely pay less if your physician prescribes a drug from the Kaiser Permanente formulary.
- Certain prescription drugs require step therapy. Step therapy is when one or more ‘first-line’ drugs is required to be used prior to the use of another ‘second-line’ drug. However, if your provider determines that a ‘first-line’ drug is not appropriate or effective for you, then a ‘second-line’ drug may be covered if you qualify for a step therapy exception.
- Certain prescription drugs may also require health plan review and prior authorization prior to dispensing. Your provider must obtain this review and prior authorization before the cost of the drug can be covered.
- For drugs subject to either step therapy or prior authorization, the prescription may be written by an in-network physician or an out-of-network physician, but must be prescribed according to our preferred drug list and policies in order to be covered.
- Out-of-Network Mail order is not supported.
- Refer to our formulary for a complete list of medications requiring step therapy or prior authorization. You may access our formulary at Choice Products Formulary (Five Tier Plan Formulary), or by calling Customer Service Monday through Friday from 8 a.m. to 6 p.m. at 1-855-364-3185 (TTY 711).
Filing Pharmacy Claims
Send your itemized bill and receipts to the following address:
MedImpact Healthcare Systems, Inc.
PO Box 509098
San Diego, CA 92150-9098
You can also email claims to Claims@Medimpact.com or fax them to 858-549-1569.
Save money on prescriptions.
- You can fill prescriptions you get from Kaiser Permanente providers and out-of-network providers at Kaiser Permanente medical centers, where you’ll usually pay the lowest copay.
- Just bring your prescription and your ID card to the medical center. To find medical centers, go to kp.org/facilities.
- If you are registered at kp.org, you’ll be able to order most refills online or by phone and have them delivered, with no cost for shipping, to your home or nearest medical center.
Find out what drugs are covered.
To find out if your prescription medications are on the plan drug formulary, you can visit the Choice Products Formulary (Five Tier Plan Formulary) for a list of approved drugs.