Regardless of the medical plan you select, prescription drug coverage is provided for both you and your family. You have the option to obtain your prescription medications either at a local pharmacy or through mail-order services. Typically, you can obtain a one-month supply of medication at a retail pharmacy. However, if you opt for mail order, you can receive a 90-day supply of your prescription.
Maintenance Medications
If you require regular and ongoing medication, such as for blood pressure or cholesterol management, opting for mail order prescription filling can lead to cost savings. With this option, a single co-payment can cover a 90-day supply of your medication.
- Capital RX/Express Scripts
- Kaiser Permanente
- Prescription Drug Benefit Comparison
- Limitations and Exclusions
Capital RX/Express Scripts
If you are enrolled in the BlueChoice HMO or CareFirst PPO plan, your prescription drug ID card is issued separately by Capital RX or Express Scripts®. When visiting a network pharmacy, it is necessary to present your ID card and make a co-payment for each prescription. Many pharmacies are part of the Capital RX and/or Express Scripts network. If you fill a prescription at a pharmacy outside this network, you will typically be responsible for the full medication cost. Subsequently, you must file a claim with your prescription drug program to seek reimbursement for the in-network expenses.
Kaiser Permanente
If you are enrolled in the Kaiser HMO plan, your prescription drug ID card is identical to your medical ID card. When you visit a network pharmacy, it’s essential to present your ID card and pay a co-payment for each prescription. The Kaiser Permanente network includes numerous pharmacies. However, if you choose to fill a prescription at a pharmacy outside of this network, you are responsible for covering the full amount charged by the pharmacy.
Prescription Drug Benefit Comparison
Limitation and Exclusions
Prescription drugs covered by your plan must be deemed medically necessary according to the carrier’s guidelines. Moreover, specific prescription medications may be subject to exclusions, limitations, or prior authorization requirements based on medical necessity. For more information, consult your carrier’s benefits booklet or reach out to your provider for clarification.