Does Kaiser cover brand name drugs?

Asked by: Fleta Bechtelar IV  |  Last update: February 11, 2022
Score: 4.2/5 (61 votes)

Your plan's list of covered drugs, known as a formulary, includes both brand-name and generic drugs.

Does Kaiser cover all medications?

Drugs on the formulary are covered by your plan's prescription drug benefit — if your plan has one. Please note that not all plans are the same. ... If your plan doesn't include a prescription drug benefit, you can still use a Kaiser Permanente pharmacy, but you'll need to pay the full retail price for your prescriptions.

How can I get insurance to pay for name brand drug?

You and your doctor can either complete and file an appeals form provided by your insurer, or write a letter that includes the name of the drug, why you need it covered, and any other supporting documents from your doctor. Your insurer's website will provide more details on the appeals process.

Does insurance cover brand name?

Health insurance companies typically publish a “formulary” that lists the drugs, both generic and brand name, that your plan will cover. Prescription formularies are developed based on efficacy, safety, and cost-effectiveness of the medications.

Does Kaiser Cover outside prescriptions?

You can fill prescriptions 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.

Is There a Difference Between Brand Name Medications and Generics?

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Can I use Kaiser at Walgreens?

Regardless of where you get care, you can fill covered prescriptions at any Kaiser Permanente pharmacy. ... MedImpact pharmacies include Walgreens, CVS, Rite Aid, Kroger, Safeway, and Costco, plus hundreds of independent pharmacies nationwide.

Can you use pill pack with Kaiser?

Thanks for your interest in PillPack. We're not compatible with Kaiser plans at this time, but we're always working on new contracts and hope to become compatible with them in the future.

Can you request brand name prescription drugs?

Fact: As a patient, you also have the right to ask for the brand-name drug if that's what you prefer. In the rare case of an inactive ingredient sensitivity, you have options. Your doctor can communicate that no substitutions are allowed or add “Dispense As Written,” or DAW, on your prescription.

Why does my insurance only cover name brand?

Some people are finding that they cannot fill their prescriptions for generic drugs at the pharmacy; their insurers will only cover the brand-name versions. ... They must have the same active ingredients and must be the “bioequivalent” of the brand name drug, delivering the same strength ingredients at the same time.

What is a generic drug vs brand name?

While brand name drug refers to the name giving by the producing company, generic drug refers to a drug produced after the active ingredient of the brand name drug. Generic drugs will, however, be sold under different brand names, but will contain the same active ingredients as the brand-name drug.

Does insurance cover brand name Adderall?

Generic Adderall is covered by some Medicare and insurance plans, but pharmacy coupons or cash prices may be lower. Compare central nervous system stimulants.

Why are some drugs not covered by insurance?

That means sometimes we may not cover a drug your doctor has prescribed. It might be because it's a new drug that doesn't yet have a proven safety record. Or, there might be a less expensive drug that works just as well.

Can insurance companies deny prescriptions?

An insurance company may deny payment for a prescription, even when it was ordered by a licensed physician. This may be because they believe they do not have enough evidence to support the need for the medication.

What is a preferred generic drug?

Your preferred drug list, sometimes called a formulary, is a list of brand-name and generic medications that are preferred by your plan. These medications are selected because they can safely and effectively treat most medical conditions while helping to contain costs for you and your plan.

How do I know if I have prescription insurance Kaiser?

To view your eligibility and the status of your coverage, you must be signed on to Once you're signed on: Select “Coverage & Costs” from the dashboard. Under “Plan Ahead,” select “Eligibility and benefits.”

Can Kaiser mail prescriptions?

Kaiser Permanente's mail order prescription refill service allows members to order their prescription refill online, and have it mailed directly to their home. The medications arrive in the mail in about a week and shipping is free.

What is a brand name drug?

A drug sold by a drug company under a specific name or trademark and that is protected by a patent. Brand name drugs may be available by prescription or over the counter.

How do I know if a drug is generic?

The medicine is the same type of product (such as a tablet or an injectable). The medicine has the same route of administration (such as oral or topical). It has the same use indications. The inactive ingredients of the medicine are acceptable.

Is Ibuprofen a brand?

The analgesic and non-steroidal anti-inflammatory drug (NSAID) ibuprofen is sold under a wide variety of brand names across the world; the most common being its first registered trademark name of Brufen, along with Advil, Motrin, and Nurofen.

Can I ask for name brand instead of generic?

Well, you can ask, but you won't get what you're looking for. You can always go from brand-name to generic, but not the other way around. If you are willing to pay more, and want the named product then they should be able to give you. It does depend on what is written on the prescription in some countries.

Are generic drugs equal to brand name products?

Generic medicines work the same as brand-name medicines

A generic medicine is required to be the same as a brand-name medicine in dosage, safety, effectiveness, strength, stability, and quality, as well as in the way it is taken. Generic medicines also have the same risks and benefits as their brand-name counterparts.

Can you substitute brand for generic?

Do most doctors know when a generic equivalent is available? NO. ... If doctors don't specify that the patient must get the brand-name product, pharmacists in California are allowed to substitute a generic as long as they tell the patient.

Can I transfer my Kaiser prescription to Walmart?

You can transfer prescriptions to Walmart for yourself and family members through your online Pharmacy: Enter the prescription holder's name and date of birth and up to seven prescriptions from a different pharmacy. For additional transfers from different people or pharmacies please create another order. Click Continue ...

Can someone else pick up your prescription Kaiser?

Simply put, yes – In most cases, someone else can pick up your prescription. However, there are usually a few extra things that person will need. For example, if the doctor gave a written prescription, the person picking up the medication will need the written prescription in order to have it filled at the pharmacy.

How long does it take Kaiser to fill a prescription?

You should receive them within 3 to 5 days. If you have questions or concerns about your prescription delivery, please call your local Kaiser Permanente mail-order pharmacy for more information. 2. Same-day and next-day prescription delivery services may be available for an additional fee.