Public Employees Retirement System

PHIP Prescription Drug Plans (PDP)

Benefits > Prescription Drug Plans > PHIP Prescription Drug Plans (PDP)

Kaiser Permanente​

Members enrolled with Kaiser Permanente through PHIP are covered under the Kaiser prescription drug benefit. Kaiser Permanente members must use Kaiser facilities and pharmacies to obtain prescription drugs.

The Kaiser Permanente prescription drug benefit covers drugs that have been approved through the Kaiser Permanente formulary process. The Kaiser Permanente formulary is developed in an ongoing process; Kaiser Permanente physicians and pharmacists evaluate scientific literature to identify the drugs best suited to treat specific medical conditions. Drugs are added to or subtracted from the formulary whenever new drugs or new information warrant this change.

Kaiser Permanente physicians remain responsible for deciding which drugs meet the individual needs of each patient.

Prescription drugs purchased at the Kaiser Permanente pharmacy

Your prescription drug coinsurance is 40 percent of the prescription charge for covered Part D drugs, up to a maximum of $250 per prescription for up to a 30-day supply. Up to a 90-day supply may be purchased at the pharmacy. The 40 percent coinsurance limit of $250 applies to each 30-day supply of covered drugs.

Mail order prescription drugs

Kaiser Permanente Mail Delivery Pharmacy can save you a trip to the medical office. The service is free, easy-to-use and fast. Orders arrive within 7 to 10 days. Members can order prescription refills by phone, via the website or by mail. For covered Part D maintenance drugs, you can order up to a 90-day supply for 40 percent of the prescription charge with a maximum limit of $500 per prescription.

Prescriptions for Kaiser Permanente members  residing in Long Term Care facilities

Patients residing in nursing homes or other long term care facilities will pay 40 percent of the prescription charge for Part D covered drugs, up to a maximum of $250 per prescription for up to a 31-day supply. Specialty packaging costs are not covered.

Moda Health

Moda Health has a comprehensive national network with more than 71,000 participating pharmacies around the United States. This includes most of the large national chains as well as many neighborhood pharmacies.

Prescription drugs purchased at the pharmacy

The member’s prescription drug coinsurance for brand name drugs is 40 percent of the discounted prescription charge, up to a maximum coinsurance of $250 for each prescription filled for up to a 31-day supply (even if the prescription is written for less than a 31-day supply). A 93-day supply of generic drugs may be obtained for up to a maximum coinsurance of $250.

Mail order prescription drugs

Mail order prescriptions can be obtained through any mail order company listed in the 2017 Moda Health PPORX (PPO) Pharmacy Directory

Prescriptions for Moda Health members residing in Long Term Care facilities

Patients residing in nursing homes or other long term care facilities will pay 40 percent of the prescription charge at the time of dispensing or upon receiving a bill from the institutional pharmacy servicing the facility.

Pacificsource

Members enrolled with PacificSource through PHIP are covered under the PacificSource prescription drug benefit.

Pharmacy network

You can access your PacificSource prescription drug benefit at retail pharmacies, through mail order or through Long Term Care (LTC) pharmacies. Our retail pharmacy network has over 68,000 pharmacies throughout the United States. This includes well-known national and regional chain pharmacies and independent pharmacies as well. Most retail pharmacies in our network allow you to get a long-term supply (up to 93 days) of maintenance drugs.

Mail order prescription drugs

Having your prescriptions delivered to you by mail can save you a trip to the pharmacy each month. The service is free, easy-to-use and fast. You can order your prescription refills by phone, on the web or by mail. Our mail order prescription service is provided by CVS or WellPartner.

Prescriptions for PacificSource members residing in Long Term Care facilities

Patients residing in a nursing home or other long term care facilities will pay 40 percent of the prescription charge for Part D covered drugs up to a maximum of $250 per prescription for up to a 31-day supply. Specialty packaging costs are not covered.

Specialty pharmacy

PacificSource does not limit or restrict which in-network Specialty pharmacy you choose to use. Specialty drugs are limited to a 31-day supply.

Providence

Members enrolled with Providence Health Plans through PHIP are covered under the Providence Health Plans prescription drug benefit. For more specific questions regarding the Providence Health Plans prescription drug benefit, please contact Providence directly.

Pharmacy network

Providence Health Plans has approximately 25,000 participating pharmacies available for use nationwide.

Preferred pharmacies

Some of our network pharmacies have preferred cost-sharing, and member responsibility may be less when using these preferred cost-sharing pharmacies. Members may also be eligible to obtain a 93-day supply of medication through these pharmacies. Our network of preferred pharmacies includes but is not limited to: Albertsons/Sav-On, Bartell Drugs, Bi-Mart, Costco, Fred Meyer, Haggen, QFC, Safeway and Walgreens.

Mail order prescription drugs

Mail-order prescriptions can be obtained through any mail order company that is not associated with another insurance carrier. Our preferred mail-order pharmacy options are Postal Prescription Services, Walgreens and Wellpartner.

Prescriptions for Providence members residing in Long Term Care facilities

Patients residing in nursing homes or other long term care facilities will pay 40 percent of the prescription charge for Part D covered drugs, up to a maximum of $250 per prescription for up to a 31-day supply. Specialty packaging costs are not covered.

Specialty pharmacy

Our preferred Specialty Pharmacy option is Credena Health, formerly known as Providence Specialty Pharmacy. Credena Health provides maintenance medication services that require specialized delivery and administration. Available medications range from self-injectable products that require refrigeration to oncology oral products. Credena Health’s pharmacists specialize in medications for a wide variety of chronic diseases.

Visit the Credena Health website online at www.credenahealth.org for additional information.

Did you know?

Once a Medicare member has paid $4,950 ($5,000 for non-Medicare members) out of pocket for eligible prescription drugs, the plan will pay 100 percent of covered prescription drugs for the remainder of the calendar year?