Pharmacy
The cost and method for filling prescriptions varies based on the medical plan you’re enrolled in. Find your medical plan below for details.
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- Health Savings Plan (HSP)
- Surest Health Plan
- Health Connect Plan (HCP)
- Hawaii Only Plan
- Kaiser HMO (WA)
- Kaiser HMO (CA)
With the Health Savings Plan (HSP), you can fill prescriptions at any retail pharmacy in the Premera network, including the on-campus Living Well Health Center pharmacy in Building 21.
Important Note: Some medications may be subject to prior authorization, step therapy, and/or quantity limits. See the Health Savings Plan Drug Formulary for a list of covered medications.
You can save money and receive up to a 90-day prescription supply delivered to your home or office by ordering your prescriptions through the Express Scripts mail order service. New mail orders typically arrive in 7-11 days; refills arrive in 3-5 days.
| Benefit | In Network Coverage | Out of Network Coverage |
| Preventive prescription drugs (see the HSP Preventive Drug List) | 100% | 100% of allowed amount |
| Prescription drugs, including brand-name (see the HSP Drug Formulary) | 90% after deductible | 90% after deductible (home delivery and specialty meds not available out of network) |
Regardless of where you fill a prescription, you’ll pay when you pick it up (or when it’s mailed if you’re using mail order). The pharmacy has real-time access to your plan information and will charge you the negotiated Premera rate for your prescriptions. They also have information on the status of your annual deductible and coinsurance.
You’ll pay the full cost for your prescription medications until you meet your annual deductible. After you reach that amount, you’ll pay 10% of the cost of your prescriptions or other care, up to your coinsurance maximum.
With the Surest Health Plan, you can fill prescriptions at any retail pharmacy in the OptumRx network, including the on-campus Living Well Health Center Pharmacy in Building 21.
Important Note: Some medications may be subject to prior authorization, step therapy, and/or quantity limits. See the Surest Drug Formulary for a list of covered medications.
If you take medications on an ongoing basis, you can also use the mail-order option through Optum Home Delivery Pharmacy. New mail orders typically arrive in 7-11 days; refills arrive in 3-5 days. Contact Optum Home Delivery at (800) 356-3477 with any questions.
| Benefit | In Network Coverage | Out of Network Coverage |
| Preventive prescription drugs (see the Surest Preventive Drug List) | 100% | 100% of allowed amount |
| Retail (up to 90-day supply for generics; up to a 30-day supply for all others) (see the Surest Drug Formulary) | Generic: $10 copay Preferred brand: $50 copay Non-preferred brand: $90 copay | Generic: $10 copay Preferred brand: $50 copay Non-preferred brand: $90 copay |
| Mail order (up to 90-day supply) See Optum Home Delivery Pharmacy | Generic: $10 copay
Preferred brand: $100 copay
Non-preferred brand: $180 copay | Not covered
|
Specialty drugs (up to a 30-day supply) Must be filled through the Optum Specialty Pharmacy | Preferred brand: $50 copay
Non-preferred brand: $90 copay |
Not covered |
With the Health Connect Plan (HCP), you can fill prescriptions at any retail pharmacy in the Premera network, including the on-campus Living Well Health Center pharmacy in Building 21.
Important Note: Some medications may be subject to prior authorization, step therapy, and/or quantity limits. See the Health Connect Plan Drug Formulary for a list of covered medications.
You can save money and receive up to a 90-day prescription supply delivered to your home or office by ordering your prescriptions through the Express Scripts mail order service. New mail orders typically arrive in 7-11 days; refills arrive in 3-5 days. Contact Express Scripts with any questions at (800) 282-2881.
| Benefit | In Network Coverage | Out of Network Coverage |
| Preventive prescription drugs (see the HCP Preventive Drug List) | 100% | 50% of allowed amount |
Retail (up to 30-day supply) (see the HCP Drug Formulary)
| Generic: $10 copay
Preferred brand: $30 copay Non-preferred brand: $60 copay | 50% of allowed amount |
Mail order (up to 90-day supply)
| Generic: $20 copay Preferred brand: $60 copay Non-preferred brand: $120 copay | Not covered |
| Specialty drugs (up to a 30-day supply) | Preferred brand: $30 copay
Non-preferred brand: $60 copay | Not covered |
With the Hawaii Only Plan, you can fill prescriptions at any retail pharmacy in the Premera network.
Important Note: Some medications may be subject to prior authorization, step therapy, and/or quantity limits. See the Hawaii Only Plan Drug Formulary for a list of covered medications.
You can save money and receive up to a 90-day prescription supply delivered to your home or office by ordering your prescriptions through the Express Scripts mail order service. New mail orders typically arrive in 7-11 days; refills arrive in 3-5 days. Contact Express Scripts with any questions at (800) 282-2881.
| Benefit | In Network Coverage | Out of Network Coverage |
| Preventive prescription drugs (see the Hawaii Only Plan Preventive Drug List) | 100% | 100% of allowed amount |
Prescription drugs, including brand-name (see the Hawaii Only Plan Drug Formulary) | 90% after deductible | 90% after deductible (home delivery and specialty meds not available out of network) |
Regardless of where you fill a prescription, you’ll pay when you pick it up (or when it’s mailed if you’re using mail order). The pharmacy has real-time access to your plan information and will charge you the negotiated Premera rate for your prescriptions. They also have information on the status of your annual deductible and coinsurance.
You’ll pay the full cost for your prescription medications until you meet your annual deductible. After you reach that amount, you’ll pay 10% of the cost of your prescriptions or other care, up to your coinsurance maximum.
With the Kaiser HMO Plan for Washington, you must use an in-network pharmacy to fill prescriptions. The Living Well Health Center pharmacy in Building 21 is considered an in-network pharmacy. Out of network pharmacies are not covered except for emergency services.
Important Note: Some medications may be subject to prior authorization, step therapy, and/or quantity limits. See the Kaiser WA HMO Drug Formulary for a list of covered medications. Contact Kaiser at (206) 630-4636 or (888) 901-4636 with any questions.
Prescription (30-to-90-day supply) | Kaiser retail copay | Kaiser mail order copay |
| Preventive and value-based drugs | $0 | $0 |
| Preferred generic | $10 | $5 |
| Preferred brand | $25 | $20 |
| Non-preferred generic and brand | $50 ($35 max for insulin) | $45 ($35 max for insulin) |
With the Kaiser HMO Plan for California, you must use an in-network pharmacy to fill prescriptions. Out of network pharmacies are not covered except for emergency services.
Important Note: Some medications may be subject to prior authorization, step therapy, and/or quantity limits. See the Kaiser CA HMO Drug Formulary for a list of covered medications. Contact Kaiser Permanente at (800) 464-4000 with any questions.
| Prescription | Kaiser CA retail copay (up to 30-day supply) | Kaiser CA mail order copay (up to 100-day supply) |
| Preventive and value-based drugs | $0 | $0 |
| Preferred generic | $10 | $20 |
| Non-preferred generic and brand | $25 | $50 |