Prescription drugs

What you need to know

Your prescription drug benefits depend on the medical plan you choose. The Kaiser HMO plan manages its own prescription drug benefits, while CVS/caremark provides prescription drug benefits for participants in the UnitedHealthcare (UHC) plans.

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Save money with these tips

Whenever possible, ask for a generic equivalent to save money, and use in-network pharmacies to avoid paying more. 

UHC and Kaiser Permanente (CA) medical plan members receive in-network maintenance drugs at no cost to help manage ongoing or chronic medical conditions, such as:

  • Diabetes
  • High blood pressure
  • High cholesterol

All of our medical plans cover certain preventive anti-cancer medications at no extra cost for women over age 35 with increased risk of breast cancer and annual screenings for certain individuals at risk for lung cancer, including CT scans of the thorax.

Need some help understanding features of the prescription drug plan? See the Terms to know page.

Additional savings for UHC members

UHC members can save 20% on thousands of CVS® brand health-related items, like pain medicine, cough and cold remedies, vitamins, and more, with the CVS ExtraCare Health Card Program, available at retail stores.

What you pay under the UHC medical plans

You can get a 30-day supply of medication from retail pharmacies.

If you're on a maintenance medication, such as high blood pressure medication, for an extended period of time, consider the mail-order option, which provides a larger quantity for a reduced copay. 

UHC participants can pick up to a 90-day supply of maintenance prescriptions at their local CVS or Target pharmacy, in addition to using the mail-order drug program.

Use these drug cost tools for an estimate of what you’ll pay:

  UHC $300 Deductible UHC CDHP with HSA*
Generic In-network: $10
Out-of-network: $10 + 50%
In-network: 10% after deductible
Out-of-network: 30% after deductible
Brand formulary In-network: $25
Out-of-network: $25 + 50%
In-network: 10% after deductible
Out-of-network: 30% after deductible
Brand non-formulary In-network: $40
Out-of-network: $40 + 50%
In-network: 10% after deductible
Out-of-network: 30% after deductible
Maintenance medications Mail order or at CVS or Target pharmacies: Up to a 90-day supply for just 2 times the retail copay amount. Check with the plan for details about mail order. Mail order or at CVS or Target pharmacies: Up to a 90-day supply for just 2 times the retail copay amount. Check with the plan for details about mail order.

*Under the UHC CDHP with HSA , deductibles and coinsurance apply. You are responsible for full prescription costs until you reach combined deductible.

Prescription Drug Out-of-Pocket Maximum

After you reach your out-of-pocket maximum, the plan pays 100% of eligible expenses for the remainder of the plan year. Under both UHC plans, prescription out-of-pocket maximums are included in the medical out-of-pocket maximum.

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What you pay under the Kaiser HMO medical plan

You can get a 30-day supply of medication from retail pharmacies.
If you're on a maintenance medication, such as high blood pressure medication, for an extended period of time, consider the mail-order option, which provides a larger quantity for a reduced copay.

  Kaiser HMO (CA)
Generic $10
Brand formulary $25
Brand non-formulary $25
Maintenance medications Mail order: Up to a 90-day supply for just 2 times the retail copay amount. Check with the plan for details about mail order

Prescription Drug Out-of-Pocket Maximum

After you reach your out-of-pocket maximum, the plan pays 100% of eligible expenses for the remainder of the plan year. Prescription out-of-pocket maximums are included in the medical out-of-pocket maximum.

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