Many FDA-approved prescription medications are covered through the benefits program. Important information regarding your prescription coverage is outlined below:
PPO Medical Plans A and B:
- Prescriptions are administered through Elixir using the “Select EX Formulary”
- The Elixir plan includes a four-tier prescription benefit. Tiered prescription plans require varying levels of payment depending on the prescription’s tier and your copayment or coinsurance will be higher with a higher tier number.
- Tier 1 includes many generic prescriptions for high blood pressure, high cholesterol, depression and diabetes.
- Tier 2 includes all other generic prescriptions . Generic prescriptions are required by the FDA to contain the same active ingredients as their brand-name counterparts.
- Tier 3 includes preferred brand name prescriptions .
- Tier 4 includes non-preferred brand name prescriptions .
- If you purchase a brand name prescription when there is a generic equivalent available, you will pay the brand copay plus the difference in cost between the brand name and the generic. Exceptions are available if the brand name medication is authorized as medically necessary by Elixir.
- Up to a 90-day supply available at retail or through mail order.
- Maintenance medication refills are required to be dispensed in a 90-day supply by a pharmacy in the Rx90 network (Elixir Pharmacy, Rite Aid, Walgreens or Costco retail pharmacy). If you are currently taking a maintenance medication, you will need to have your prescription transferred to an Rx90 network pharmacy. For a list of maintenance medications, please visit www.ElixirSolutions.com.
- Specialty medications must be filled by Elixir Specialty Pharmacy, with the exception of limited distribution prescriptions . For questions or to learn more, please visit www.ElixirSolutions.com or call 877.437.9012.
- Certain specialty medications are subject to a variable copayment. Elixir Specialty Pharmacy representatives will help you enroll in prescription manufacturer assistance to reduce your out-of-pocket costs below the standard copayment tiers described above. If you are ineligible for the prescription manufacturer assistance program, the standard copayment tiers apply.
Why pay more for prescriptions?
Use Mail Order
Shop Around
Over-the-Counter Options
Save time and money by
utilizing a mail order
service for maintenance
medications. A 90 or 100-
day supply of your
medication will be shipped
to you, instead of a typical
30-day supply from a
walk-in pharmacy
Some pharmacies, such
as those at warehouse
clubs or discount stores,
may offer less expensive
prescriptions than
others. Call ahead to
determine which
pharmacy provides the
most competitive price.
For common ailments,
over-the-counter prescriptions
may provide a less
expensive alternative
that serves the same
purpose as prescription
medications.
Deductible HMO Plan C:
- The Kaiser prescription plan includes a two-tier prescription benefit.
- Tier 1 includes generic prescriptions . Generic prescriptions are required by the FDA to contain the same active ingredients as their brand-name counterparts.
- Tier 2 includes preferred brand name prescriptions . Non-preferred brand name and specialty prescriptions are covered under Tier 2 if approved through an exception process.
- Up to a 30-day supply available at retail, and up to a 100-day supply through mail order.
- For a Kaiser formulary prescription list(s) or more information on the mail order service, go to www.kp.org/formulary.