Kaiser Southern California Prescription Drug Coverage

2020 Plan Year Information

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.

Kaiser Permanente Prescription Drug Coverage

Participating Retail Pharmacy Mail Service
Generics

$5 copay for 100-day supply
$15 copay for up to 30-day supply

Not available
$30 for up to 100-day supply

Preferred and Non-Preferred Brand Name Drugs

$15 copay for 100-day supply
$30 copay for up to 30-day supply

Not available
$60 for up to 100-day supply

Specialty Drugs

Subject to Kaiser’s determination. Contact Kaiser for details.
30% coinsurance up to $150 maximum for 30-day supply

Not available
$60 for up to 100-day supply