Applicable copay will apply based on whether the medication is generic, preferred brand or non-preferred brand (or specialty where applies) and if it is being field at an Option 1, 2 or 3 pharmacy. Members can fill prescriptions that they get from out-of-network physicians at Kaiser Permanente medical center pharmacies, where they will usually. Prescription drug coverage. Covered items in accord with our drug formulary when obtained at Plan pharmacies. $10 up to a 30-day supply. Brand-name drugs. $35 up to a 30-day supply. Mail-order program. $20 generic/$70 brand for a 100-day supply of most maintenance drugs. Prescription History Request Form. Please use the form below to obtain your prescription history. Complete and mail to: Kaiser Permanente Pharmacy Informatics PO Box 5075 Livermore, CA. Prescription History Request Form. Kaiser Permanente health plans around the country: Kaiser Foundation Health Plan, Inc., in Northern and Southern California and Hawaii. Kaiser Foundation Health Plan of Colorado. Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305, 404-364-7000. Kaiser Foundation Health Plan of. You'll pay either our full copay rate or reduced copay rate. If you live in a high-cost area, you may qualify for a reduced inpatient copay rate no matter what priority group you're in. To find out if you qualify for a reduced inpatient copay rate, call us toll-free at 877-222-8387. We're here Monday through Friday, 8:00 a.m.
Mail Order Prescription Service
Mail Order Prescription Service includes free shipping and is available when you:
1. Order online using our online prescription service: Online Prescription Refills
2. Please use our Easy-fill refill phone system 24-hours a day. Please see below for the EasyFill phone numbers for Fremont, Hayward, and Union City.
3. Call our Mail Order Pharmacy at (888) 218-6245. Choose to have your prescriptions mailed at no additional charge. Please allow 2 to 3 business days for arrival.
4. Pick up our convenient Mail Order Prescription Envelopes at any of our pharmacies.
Prescriptions Refills
1. Order your prescription refills and pick them up at the location of your choice (may take up to 24 hours).
2. Order Zero Refills, No refill remaining (may take up to two business days).
3. Have your prescriptions mailed directly to your home.
4. Check to see if your new or refilled prescriptions are ready.
Prescription Refills Online
To order a prescription refill or check the status of a refill, visit our prescription center: Online Prescription Refills.
Rethink Refills – More detailed information on how to refill your prescriptions online.
Prescription EasyFill Refills by Phone
Fremont
Niles Building – First Floor: 510-248-3359
Niles Building – Third Floor: 510-248-3786
Ohlone Building: 510-248-3140
Hayward and Union City
Hayward – Hospital Main: 510-784-4221
Hayward – Sleepy Hollow: 510-784-4591
Union City – Building A: 510-675-3301
Union City – Building B: 510-675-2065
Prescription History Request Form
Please use the form below to obtain your prescription history. Complete and mail to:
Kaiser Permanente
Pharmacy Informatics
PO Box 5075
Livermore, CA 94511-5075
Part D (prescription drug coverage)
Medicare Parts A and B do not cover the cost of most prescription drugs. Medicare Part D is a prescription drug benefit that was introduced in 2006. Part D is optional and has a monthly premium. However, you may have to pay a late enrollment penalty if you don't enroll when you're first eligible. Part D is available through private companies, and plans must be approved by Medicare. All Part D plans have to meet certain standards set by the government, but after that, plans can vary — with different premiums, drug costs, and drugs that are covered.
You can get Part D as a stand-alone drug plan in addition to Original Medicare or a Medigap plan, or you can get it as part of a Medicare Advantage plan that includes both your medical and prescription coverage. You cannot purchase a stand-alone Part D plan in addition to a Medicare Advantage plan. Doing so will disenroll you from the Medicare Advantage plan (Part C), and you'll go back to Original Medicare.
How Part D coverage works
Part D is designed with 4 stages. Your coverage changes from one stage to the next as your drug costs add up over the calendar year. Below is a description of the standard 2021 Part D benefit. (Your plan may have different costs.)
1. First, you pay your plan's Part D deductible, which means you pay all your drug costs out of pocket until you reach your plan's deductible amount.
2. Next, you pay just a copay or coinsurance, set by your health plan, until your total drug costs reach $4,130 in covered drug costs. That total includes what you've paid out of pocket, as well as what your health plan has paid. Most people don't reach this amount, but if you do, you'll move into the coverage gap.
3. The coverage gap is sometimes called the 'donut hole' because you have less coverage. You're in the gap until you reach $6,550 in out-of-pocket expenses. This total includes everything you've paid for covered drugs from the beginning of the year, as well as the dollar value of any discounts you receive on brand-name drugs while you're in the gap.
4. After you reach the out-of-pocket limit, you move into the last stage of coverage where you pay a low coinsurance or fixed fee for the rest of the year.
On January 1, your coverage starts over again in the deductible stage.
Medicare Part D covers:
All outpatient drugs mandated by Medicare. Coverage rules such as limitations and preauthorizations may apply.
Medicare Part D does not cover:
Does Kaiser Cover Prescriptions
- Drugs not on the Medicare formulary
- Certain drugs that are covered under Medicare Part B
Eligibility
- You're eligible for Part D if you have Part A and/or Part B.
- You must live in your chosen plan's service area to enroll.
- You can only enroll in one Part D plan at a time. ('Double coverage' is not allowed.)
When to enroll
- When you first become eligible for Medicare.
- Annual Enrollment Period for Medicare Advantage and Part D plans: October 15 through December 7 each year.
If you don't enroll in Part D when you're first eligible for Medicare, and you decide to enroll later, you could be charged a higher monthly Part D premium. Find out how the penalty is calculated on Medicare's website.
Before selecting a Medicare Part D plan, see if the prescription drugs you currently take are on the plan's formulary (list of covered drugs), and what the costs are. You can visit www.medicare.gov to compare Medicare Part D prescription drug plans.
Kaiser Prescription Copay Plan
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