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How it works: Maintenance medication first fills and refills

The efficiency and cost-effectiveness of Kaiser Permanente Washington’s pharmacy program is an integral part of our integrated model of care and an important part of the way we make care more affordable for employers and their employees. We know that members experience higher quality outcomes and improved patient experiences when medications are filled internally within the Kaiser Permanente pharmacy system. That’s why we’re driving the use of Kaiser Permanente’s pharmacies for maintenance medications, which are drugs used on a continuing basis for the treatment of chronic conditions, such as diabetes and rheumatoid arthritis.

Here’s how it works for most plans1:

  1. Members can get their first fill of a maintenance medication at any Kaiser Permanente or contracted network pharmacy.
  2. After the first fill, members must use a Kaiser Permanente retail pharmacy or the Kaiser Permanente mail-order service.2
  3. If a member uses a contracted network pharmacy, the member will receive a letter within 7 to 14 days explaining the simple process to transfer their prescription to Kaiser Permanente’s pharmacy system to obtain refills.
  4. If a member attempts a second fill at a network pharmacy, the member will be allowed a courtesy second fill but will receive an additional letter reminding them to transfer their prescription to Kaiser Permanente’s pharmacy system.
  5. Once a member has established their maintenance medication prescription within the Kaiser Permanente pharmacy system, it’s easy to order refills by phone, online, or via the Kaiser Permanente Washington app. Members can also opt into our automatic refill program; they’ll receive their refills before they run out of their current supply, and they don’t need to call or log in to order.

Other prescription drugs (non-maintenance medications)

There are no restrictions on fills for drugs excluded from this feature, for acute medical situations, or for medications we cannot mail. These medications may be filled at any Kaiser Permanente or other network pharmacy.

Benefits of using Kaiser Permanente pharmacies

This change helps reduce costs for many of our plan members, which is reflected in their premium. Additionally, when members use Kaiser Permanente pharmacies, their pharmacy data is integrated with the rest of their clinical information. This helps Kaiser Permanente doctors, care teams, and pharmacists view prescription use, provide safer prescriptions, and avoid dangerous drug interactions. In short, patient care improves when our team of providers works together to coordinate a member’s entire experience, pharmacy included.

Among the many other conveniences for members using Kaiser Permanente pharmacies:

  • Online and mobile app refill ordering
  • Automatic prescription refill program
  • Reliable and fast mail-order delivery
  • Same-day delivery in some areas; available for a fee
  • Online pharmacy chat
  • Pharmacy representatives available by phone

For more information about Kaiser Permanente Washington’s pharmacy services, visit kp.org/wa/pharmacy. For questions about our first fill and refill rules for most plans, please contact your Kaiser Permanente Sales representative.

 

1These maintenance medication guidelines apply to small group plans using Core HMO or Connect networks and to all individual and family plans. They do not apply to Medicare Advantage plans or Small Group Access PPO or Elect PPO plans. Large Group employers have the option to add this feature to Core HMO and Access PPO plans; it is not mandatory.

2Virtual Plus plan members may only use the Kaiser Permanente mail-order pharmacy to refill maintenance medications.

All plans offered and underwritten by Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc.

© 2021 Kaiser Foundation Health Plan of Washington