2 comments on “Kaiser Permanente – New Enrollment – Administrative”

1. What medications are in the formulary for psoriasis?

   Enbrel,
   Humira,
   Stelara,
   Talz, and others

   Reply

   • VIDEO explanation

     Kaiser Drug Formulary Use the CA Commercial Formulary

     I’m checking to verify if your group has a 2 or 3 tier formulary. Also, we will check the Co-Pays and Tiers for your group…
     See plan highlights for general information and your co pays

     Your group has the option of The Silver 70 HMO 1650/55 and The Silver 70 HDHP 2500/20% HMO

     What do the abbreviations mean?
     

     Use Ctrl F to search for the Rx you want to check out

     

     Tier level and quantity level – See highlights above for co pays or just wait till I get the EOC

     

     Just as an FYI – See our webpage Q & A for Medicare Part D Rx on Enbrel & Humira

     

     Taltz list price is $6k/month per their website

     Kaiser Small Group Evidence of Coverages

     Please review the Formulary Exception Process on page 54
     EOC #2 – Kaiser Permanente for Small Business Combined Evidence of Coverage and Disclosure Form for {SAMPLE}Kaiser Permanente Silver 70 HMO 1650/55 + Child Dental Alt INFGroup ID: {PID} EOC Number: 2

     See also the EOC on grievances – our webpage on grievances and appeals.

     I haven’t seen where Metal Level has anything to do with the formulary, in fact it’s probably prohibited, as only the co pays and deductibles are supposed to be different. Here’s where we did extensive research on Flomax and shouldn’t it be covered on a Platinum Plan?

     Cal COBRA?

     FYI – Medicare Part D has a shopping tool, that tells you at ONE time, all the plans and if they cover what prescriptions – I’m not aware of a feature like that for Small Group or Individual.

     Reply