Pharmacy
Prescription coverage is part of your KP Plus plan. Where you choose to have your prescriptions filled will determine how much you pay for your medications. Your pharmacy options include Kaiser Permanente and affiliated pharmacies in California, as well as out-of-network pharmacies for most prescriptions. You can choose any pharmacy option regardless of the prescribing provider.
Kaiser Permanente Pharmacies
Prescriptions through Kaiser Permanente and affiliated pharmacies
You can fill prescriptions (written by any provider) at Kaiser Permanente pharmacies located in California. You will generally pay the lowest out-of-pocket costs at these pharmacies. Choose how to fill your prescriptions:
- At Kaiser Permanente medical facilities. Most Kaiser Permanente medical centers and medical offices have pharmacies. When you get care at a Kaiser Permanente location, you can usually pick up prescriptions your doctor writes before you even leave the building.
- Online. Register at kp.org/register to order most refills online and have them mailed to you with no cost for shipping.*
- Through the refill phone line. Call us at one of the following numbers and have the medication mailed to you.*
Northern California 1-888-218-6245 (TTY 711)
Southern California 1-866-206-2983 (TTY 711)
When filling a prescription at a Kaiser Permanente pharmacy, the information will become part of your Kaiser Permanente medical record for better-coordinated care. If you present a prescription from an out-of-network provider 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.
To find your nearest Kaiser Permanente pharmacy, visit kp.org/facilities.
If you’re not near a Kaiser Permanente facility, you also have the option to get your initial prescription filled at one of our network pharmacies like Rite Aid or Walgreens.
* You can get most prescriptions delivered within 3-7 days of ordering, at no extra cost with standard shipping. Most medications can be delivered by mail. Restrictions may apply. Some medications, such as ones that need to be refrigerated, aren’t eligible for mail order.
Out-of-Network Pharmacies
- You have 5 fills or refills within any licensed out-of-network pharmacy each contract year.
- An out-of-network fill is any prescription service that is received out-of-network. Multiple prescriptions in the same pharmacy visit on the same day will count as multiple fills and will each count towards the annual limit.
- For example, filling a prescription or getting a vaccine for the following will count as 3 fills toward the 5-fill limit: 1 antibiotic prescription, 1 flu shot, and 1 eye drop prescription.
- You may need to pay for prescriptions filled at out-of-network pharmacies in full, and then submit a claim for reimbursement.
- Send your receipt and copy of the portion of the prescription label that contains the drug name/prescription information to the address below for reimbursement. Once we receive the documentation, if your drug is covered, you’ll be reimbursed for the cost of the drug, minus your out-of-network benefit cost share.
Northern California Region
KFHP Claims Department
P.O. Box 12923, Oakland, CA 94604-2923
Southern California Region
KFHP Claims Department
PO Box 7004, Downey, CA 90242-7004
- To check if a medication is on the Kaiser Permanente formulary, go to kp.org/formulary, choose your region, and select the HMO Formulary link or call KP Plus Customer Service Monday through Friday from 7 a.m. to 7 p.m. Pacific Time at 1-800-788-0710 (TTY 711).
What’s Not Covered with the Out-of-Network Benefit:
- Non-formulary drugs
- Fertility drugs
- Weight loss drugs, sometimes called “GLP-1 drugs”
- Drugs on Tier 4 in our drug formulary, sometimes called “specialty drugs”
- Anticancer drugs and certain critical adjuncts following a diagnosis of cancer
- Home infusion drugs
- Mail order delivery of prescription drugs
To find out more about what is covered under the out-of-network benefit:
- Refer to your Evidence of Coverage (EOC).
- Call Customer Service at 1-800-788-0710 (TTY 711), Monday through Friday, 7 a.m. to 7 p.m., Pacific time, or refer to your ID card.
Save money on prescriptions.
- You can fill prescriptions you get from Kaiser Permanente providers and out-of-network providers at Kaiser Permanente medical facilities, where you’ll usually pay the lowest copay.
- Just bring your prescription and your ID card to the medical facility. To find Kaiser Permanente medical facilities, go to kp.org/facilities. Kaiser Permanente pharmacies also accept electronic prescriptions in addition to prescriptions written on paper.
- If you are registered at kp.org, you’ll be able to order most refills online or by phone and have them delivered, with no cost for shipping, to your home or nearest medical facility. * Mail order delivery of prescription drugs is not covered with the with the Out-of-Network Benefit.
Find out what drugs are covered.
Not all drugs on the drug formulary are covered when obtained from an out-of-network pharmacy. For example, anticancer and other drugs on Tier 4 in our drug formulary, sometimes called “specialty drugs”, are not covered. Refer to your Evidence of Coverage (EOC) to find out which drugs are excluded out-of-network. Contact the human resource/benefits officer where you work for your copy of your EOC.
*Not all prescriptions can be mailed, restrictions may apply. Please check with your local pharmacy.