The Kansas State Employees Prescription Benefit Plan

The Kansas State Employees Prescription Benefit Plan is a five-tier program designed to encourage plan participants to partner with their physicians in choosing cost-effective medications when needed for the treatment of illness or injury. The AdvancePCS Pharmacy and Therapeutics Committee manages the clinical formulary and assists the State in determining the appropriate tiers for the level of coverage.

NOTE: The preferred drug list is a subset of the clinical formulary.

Tier One Generic Drugs Member Pays - 20% coinsurance

Tier Two Preferred Brand-Name Drugs (formerly 'formulary drugs') Member Pays - 30% coinsurance

Tier Three Special Case Medications 1 Member Pays - $70 copay per prescription

Coinsurance/ Copay Maximum Tiers One, Two and Three only Member Pays - $2,400 per person per year.

Tier Four Non-Preferred Brand-Name Drugs and Compounded Medications Member Pays - 50% coinsurance.

Tier Five Lifestyle Medications 2 Member Pays - 100% of the discounted price.

Initial fill of any prescription is limited to one standard unit of therapy or a 30-day supply, whichever is less. Refills may be obtained after 75 percent of the previous fill has been consumed. Medications may be refilled for two standard units of therapy or up to a 60-day supply as long as the previous fill was within 90 days.

AdvancePCS offers a MAIL-ORDER pharmacy with lower costs.

NOTE: It is the treating physician and the patient, not the prescription benefit plan or the employer, who determines the course of prescription drug treatment. Whether or not the plan will cover all or part of the treatment costs is secondary to the decision of what the treatment should be.

Source: RefillPill.com Editors' Choice