Pharmacy
Prescription medicine coverage is part of your Choice Products plan. Where you choose to have your outpatient prescription drugs filled will determine how much you pay for your medicines. You have several pharmacy options: Kaiser Permanente Pharmacies, In-Network Pharmacies (MedImpact Pharmacies), or Out-of-Network Pharmacies. You can choose any pharmacy option regardless of the prescribing provider tier status. You can also fill prescriptions you get from In-Network and Out-of-Network Providers at Kaiser Permanente Pharmacies. See below for additional criteria for refills on maintenance medications (for ongoing conditions such as blood pressure, cholesterol, diabetes, etc.).
Kaiser Permanente Pharmacies
Prescriptions through Kaiser Permanente pharmacies.
You can fill prescriptions (written by any provider) at pharmacies located in Kaiser Permanente medical offices. You will generally pay the lowest out-of-pocket costs at these pharmacies. Choose how to fill your prescriptions:
- At Kaiser Permanente medical offices. Most Kaiser Permanente medical offices across the region have pharmacies. Kaiser Permanente doctors can send most prescriptions electronically to the pharmacy—or you can present your prescription with your ID card.
- Online. Register at kp.org/register to order most refills online and have the medicine mailed to you.
- Through the Refill phone line. Call us at 1-866-523-6059 (TTY 711) 24 hours a day, and have the medicine mailed to you or available for pick up at any medical office.*
To choose the Kaiser Permanente pharmacy where you’d like to pick up your prescription, visit the Kaiser Permanente Pharmacy Directory.
Maintenance Medication Refill requirement.
Unless your employer has opted out of this requirement, the first prescription for a Maintenance Medication may be filled at any pharmacy. However, if a maintenance medication prescription will be refilled within a 30-mile radius of a Kaiser Permanente operated pharmacy located within a Kaiser Medical Office Building then a Kaiser Permanente pharmacy or the Kaiser Permanente mail order must be used to refill the prescription or the refill will not be covered.
Prior Authorization of Outpatient Prescription Drugs (for certain drugs, step therapies, age, and quantity limits for Kaiser Permanente, MedImpact and Non-Participating Pharmacies):
Members will need to get Prior Authorization for certain outpatient prescription drugs. We’ve partnered with MedImpact to help ensure that outpatient prescription drugs ordered by your doctor are medically necessary, cost-effective, and the most appropriate treatment for your condition. Prior Authorization will be required on certain medications. Before you receive certain outpatient prescription drugs, your physician should request Prior Authorization, by completing and submitting the KPIC Prior Authorization in writing. You can reach MedImpact at 1-800-788-2949 (TTY 711), Monday through Friday, 8 a.m.–6 p.m., Mountain time.
Find out what drugs are covered.
- To find out if your prescription medications are on the Plan drug formulary and if there are restrictions, you can visit the KPIC Colorado POS and PPO Formulary or KPIC Colorado POS and PPO Formulary en espanol for a list of approved drugs.
How to save money on prescriptions.
- You can fill prescriptions you get from In-Network and Out-of-Network Providers at Kaiser Permanente medical offices, where you’ll usually pay the lowest copay.
- Just bring your prescription and your ID card to the medical office. To find medical offices, go to kp.org/facilities.
- If you are registered at kp.org, you’ll be able to order refills online or by phone and have them delivered, with no cost for postage (applies to most drugs).
- If you present a prescription for a drug that is not on the Kaiser Permanente formulary, the Kaiser Permanente pharmacist will likely check with the prescribing physician to determine if a therapeutic equivalent from the Kaiser Permanente formulary can be substituted.
- This prescription information will become part of your Kaiser Permanente medical record, for better coordinated care.
In-Network Pharmacies
Prescriptions through In-Network retail pharmacies.
- You can fill prescriptions (written by any provider) at MedImpact pharmacies.
- Kaiser Permanente Insurance Company contracts with MedImpact to fill your outpatient prescription drugs at retail pharmacies across the country.
- You can use any of the retail pharmacies nationwide in the MedImpact In-Network pharmacy network.
You can fill prescriptions at any In-Network MedImpact pharmacy. Here’s a partial list:
- Rite Aid
- Safeway
- Walgreens
Not all locations in a chain are in-network; some are independently contracted. To check on a specific pharmacy or for more information, call MedImpact Customer Service at 1-800-788-2949 (TTY 711) at any time or check the Kaiser Permanente Pharmacy Directory.
Maintenance Medication Refill requirement.
Unless your employer has opted out of this requirement, the first prescription for a Maintenance Medication may be filled at any pharmacy. However, if a maintenance medication prescription will be refilled within a 30-mile radius of a Kaiser Permanente operated pharmacy located within a Kaiser Medical Office Building then a Kaiser Permanente pharmacy or the Kaiser Permanente mail order must be used to refill the prescription or the refill will not be covered.
Prior Authorization of Outpatient Prescription Drugs (for certain drugs, step therapies, age, and quantity limits for Kaiser Permanente, MedImpact and Non-Participating Pharmacies):
Members will need to get Prior Authorization for certain outpatient prescription drugs. We’ve partnered with MedImpact to help ensure that outpatient prescription drugs ordered by your doctor are medically necessary, cost-effective, and the most appropriate treatment for your condition. Prior Authorization will be required on certain medications. Before you receive certain outpatient prescription drugs, your physician should request Prior Authorization, by completing and submitting the KPIC Prior Authorization in writing. You can reach MedImpact at 1-800-788-2949 (TTY 711), Monday through Friday, 8 a.m.–6 p.m., Mountain time.
Find out what drugs are covered.
- To find out if your prescription medications are on the PPO and POS Covered Drug List, click KPIC Colorado POS and PPO Formulary for a list of covered drugs
Submit Pharmacy Claims to:
MedImpact Healthcare Systems, Inc.
P.O. Box 509098
San Diego, CA 92150-9098
Expected pharmacy review turnaround times for prescriptions that require prior authorization:
Urgent Requests: 24 hours
Standard Requests: 48 hours
Out-of-Network Pharmacies
Fill your prescription (written by any provider) at any pharmacy.
- You will pay full out-of-pocket costs for prescriptions filled at Out-of-Network pharmacies and then submit claims for reimbursement.
Prior Authorization of Outpatient Prescription Drugs (for certain drugs, step therapies, age, and quantity limits for Kaiser Permanente, MedImpact and Non-Participating Pharmacies):
Members will need to get Prior Authorization for certain outpatient prescription drugs. We’ve partnered with MedImpact to help ensure that outpatient prescription drugs ordered by your doctor are medically necessary, cost-effective, and the most appropriate treatment for your condition. Beginning on Jan. 1, 2018, as plans renew, Prior Authorization will be required on certain medications. Before you receive certain outpatient prescription drugs, your physician should request Prior Authorization, by completing and submitting the KPIC Prior Authorization in writing. You can reach MedImpact at 1-800-788-2949 (TTY 711), Monday through Friday, 8 a.m.–6 p.m., Mountain time.
Maintenance Medication Refill requirement.
Unless your employer has opted out of this requirement, the first prescription for a Maintenance Medication may be filled at any pharmacy. However, if a maintenance medication prescription will be refilled within a 30-mile radius of a Kaiser Permanente operated pharmacy located within a Kaiser Medical Office Building then a Kaiser Permanente pharmacy or the Kaiser Permanente mail order must be used to refill the prescription or the refill will not be covered.
Prior Authorization of Outpatient Prescription Drugs (for certain drugs, step therapies, age, and quantity limits for Kaiser Permanente, MedImpact and Non-Participating Pharmacies):
Members will need to get Prior Authorization for certain outpatient prescription drugs. We’ve partnered with MedImpact to help ensure that outpatient prescription drugs ordered by your doctor are medically necessary, cost-effective, and the most appropriate treatment for your condition. Prior Authorization will be required on certain medications. Before you receive certain outpatient prescription drugs, your physician should request Prior Authorization, by completing and submitting the KPIC Prior Authorization in writing. You can reach MedImpact at 1-800-788-2949 (TTY 711), Monday through Friday, 8 a.m.–6 p.m., Mountain time.
Find out what drugs are covered.
- To find out if your prescription medications are on the PPO and POS Covered Drug List, click KPIC Colorado POS and PPO Formulary for a list of covered drugs
Pharmacy Claims Address:
MedImpact Healthcare Systems, Inc.
P.O. Box 509098
San Diego, CA 92150-9098
Expected pharmacy review turnaround times for prescriptions that require prior authorization:
Urgent Requests: 24 hours
Standard Requests: 48 hours