Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 3813 Prescription Benefits Prescription Benefits At-A-Glance (For Non-Medicare prescription drug coverage) When to Use Your Benefit: Where: Cost to You: Web Services: Kaiser Permanente Medical Center (Preferred) For immediate or short term prescriptions: Prescriptions can be filled at a Kaiser Permanente Medical Center. Please Note: Copays are lower when filled at a Kaiser Permanente Medical Center vs. a community network pharmacy. Up to a 30-day supply: •  $10 for generic. •  $20 for brand name drugs. •  $45 for non-preferred drugs. Up to a 90-day supply: •  $20 for generic. •  $40 for brand name drugs. •  $90 for non-preferred drugs. Community Based/ Network Pharmacy For immediate or short term prescriptions: Prescriptions can also be filled at community pharmacies such as: Giant®, Safeway®, Rite Aid®, Target®, Wal-Mart®, and K-Mart®. Please Note: Copays are higher when filled at a community network pharmacy. Up to a 30-day supply: •  $20 for generic. •  $35 for brand name drugs. •  $55 for non-preferred drugs. Up to a 90-day supply: •  $40 for generic. •  $70 for brand name drugs. •  $110 for non-preferred drugs. Mail Order Program (Preferred) For short term, maintenance and long term prescriptions: You can have prescriptions mailed right to your home through the Kaiser Permanente Mail order program. Up to a 90 day supply: •  $20 for generic. •  $40 for brand name drugs. •  $90 for non-preferred drugs. Members are able to order prescription refills online or check the status of a prescription refill for yourself or another member, and review a list of covered drugs though the members only section of the Kaiser Permanente web site, www.kp.org.