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  • Non-formulary Prescription Form - Kaiser Permanente - Community ... - Providers Kp

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Member Name (print): Non-Formulary Prescription Form Fax Completed Form to 404-467-2731 or call 404-365-4159 for a real time review. Kaiser Permanente Health Record Number: DOB: Print or Stamp below:.

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At Kaiser Permanente, we use telehealth for preventive care and chronic condition management, not just for simple one-time health care needs. And telehealth is a component of our integrated care program not an add-on. It's available to all members and built into your company's health plan.

If a medication is non-formulary, it means it is not included on the insurance company's formulary or list of covered medications. A medication may not be on the formulary because there is an alternative proven to be just as effective and safe, but is less costly.

Effective April 1, 2011, Kaiser Permanente HMO members now need to get prescription refills at one of our convenient Kaiser Permanente medical facility pharmacies or through our mail order refill service. ... To refill prescriptions filled at Rite Aid or Walgreens, you'll first just need to transfer them.

Kaiser Permanente and affiliated pharmacies. You can only get your prescription drug benefit at Kaiser Permanente or affiliated pharmacies, except in non-routine situations. Fill your prescriptions at any Kaiser Permanente or affiliated pharmacy or through our mail-order service.

Refill prescriptions Get refills through the mail, or pick them up at a pharmacy near you. Call the EZ Refill number, 1-800-700-1479 or the number on your prescription label, 24 hours a day. Go in person. Find a pharmacy or affiliated pharmacy (depending on your plan).

Kaiser Permanente Pharmacies will fill most of your prescriptions written by both participating and licensed non-participating providers and offers the convenience of mail-order service for most drugs. ... You can use any of the nearly 60,000 retail pharmacies nationwide in the MedImpact participating pharmacy network.

Prescriptions for non-formulary medications may be filled at Kaiser Permanente pharmacies. However, you should expect to pay the full retail cost unless your doctor has obtained an exception. Drugs not normally covered by your Kaiser Permanente prescription drug benefit include: drugs prescribed for cosmetic purposes.

Depending on your plan, you can fill prescriptions: at a Kaiser Permanente medical office pharmacy. through the Kaiser Permanente Mail Order Pharmacy service. at a network pharmacy (King Soopers, Walgreens, etc.)

Regardless of where you get care, you can fill covered prescriptions at any Kaiser Permanente pharmacy. ... MedImpact pharmacies include Walgreens, CVS, Rite Aid, Kroger, Safeway, and , plus hundreds of independent pharmacies nationwide.

To transfer a prescription, contact our NCAL Call Center at 1-888-218-6245 or online at kp.org/rxrefill. For urgent transfers (requiring same day pick up), please contact your local pharmacy.

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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232