Hawaii Prescription Drugs
2024 Plan Information
Participating Retail Pharmacy | Mail Service | Non-Participating Retail Pharmacy |
---|---|---|
Individual Out-of-Pocket Maximum | ||
$3,600 (combined with Mail Service and Non-Participating Retail Pharmacy) | $3,600 (combined with Participating and Non-Participating Retail Pharmacy) | $3,600 (combined with Mail Service and Participating Retail Pharmacy) |
Family Out-of-Pocket Maximum | ||
$4,200 (combined with Mail Service and Non-Participating Retail Pharmacy) | $4,200 (combined with Participating and Non-Participating Retail Pharmacy) | $4,200 (combined with Mail Service and Participating Retail Pharmacy) |
Generic Drug | ||
$7 copay for 30-day retail supply | $11 copay for 90-day mail order supply | $7 copay plus 20% coinsurance per prescription No coverage for mail order |
Tier 2: Preferred Brand-Name Drug | ||
$30 copay for 30-day retail supply | $65 copay for 90-day mail order supply | $30 copay plus 20% coinsurance per prescription retail No coverage for mail order |
Tier 3: Other Brand Name Drugs | ||
$30 copay for 30-day retail supply | $65 copay for 90-day mail order supply | $30 copay plus 20% coinsurance per prescription No coverage for mail order |
Tier 4: Preferred Specialty Drugs | ||
$100 copay for 30-day supply Retail benefit limited to 30-day supply | Not covered | Not covered |
Tier 5: Other Brand Name Specialty Drugs | ||
$200 copay for 30-day retail supply Retail benefit limited to 30 day supply | Not covered | Not covered |
For skilled administration drugs, you will pay $20 copay per dose per day. Generally, a skilled administration drug is one that requires administration by a physician or nurse. Contact HMSA regarding questions about which types of drugs are skilled administration drugs.
You are responsible for charges over R&C as determined by HMSA.
Lifetime benefits are unlimited, except for infertility benefits. For more information, contact HMSA.
HMSA Prescription Drug Deductible
The HMSA Medical Plan does not have a separate deductible for prescription drugs. Your prescription drug copays count toward the program’s individual and family deductibles.
Kaiser Permanente Prescription Drug Coverage
Participating Retail Pharmacy | Mail Service |
---|---|
Generic Maintenance Medications | |
$3 copay for 30-day retail supply | $6 copay for 90-day mail order supply |
Other Generics | |
$15 copay for 30-day retail supply | $30 copay for 90-day mail order supply |
Preferred Brand/Non-Formulary Preferred Brand Drugs | |
$50 copay for 30-day retail supply | $100 copay for 90-day mail order supply |
Specialty Drugs | |
$200 copay for 30-day retail supply | $400 copay for 90-day supply |
Prescription Drug Deductible and Out-of-Pocket Maximum
This Medical Plan does not have a separate deductible or out-of-pocket maximum for prescription drugs. Your prescription drug copays count toward the annual deductible and out-of-pocket maximum amounts.