Pharmacy

Contracted Pharmacies

Prescriptions through designated contracted pharmacies.

• Kaiser Permanente Insurance Company contracts with MedImpact designated pharmacies to fill your outpatient prescription drugs at retail pharmacies across the country.
• To locate available MedImpact pharmacies, go to the Added Choice Provider Directory. Select the Pharmacy category, then select “MedImpact Network Pharmacies” and enter your location.
• To find a list of approved drugs when selecting a Contracted Pharmacy, visit the Kaiser Permanente Formulary site. Select the Hawaii region, then select the formulary from the “Kaiser Permanente Insurance Company (KPIC)” drop-down menu.

Not all locations in a chain participate, some are independently contracted. To check on a specific pharmacy or for more information, call MedImpact Customer Service at 1-800-788-2949 (TTY 711) at any time.

Not all plans have coverage for outpatient prescription drugs. Please consult your Benefits Summary or Group Medical and Hospital Service Agreement and KPIC Certificate of Insurance for more information about your coverage.

Submit Pharmacy Claims to
MedImpact Healthcare Systems, Inc.
PO Box 509098
San Diego, CA 92150-9098

Expected pharmacy review turnaround times for prescriptions that require prior authorization:

Urgent Requests: 24 hours
Standard Requests: 48 hours

What if my pharmacy claim is denied?

If we have denied coverage for certain prescription drugs, in whole or in part, then you may request that we review this decision, also referred to as an “adverse benefit determination.”

You, or a representative whom you formally appoint in writing, have the right to appeal our decision by asking that we review it.  To appeal the decision, please send your request for review in writing, to:

KPIC Pharmacy Administrator
Grievance & Appeals Coordinator 
10181 Scripps Gateway Court 
San Diego, CA 92131
(800) 788-2949

Or you can fax the letter to (858) 790-6060, Attn: KPIC Pharmacy Administrator Grievance and Appeals Coordinator.

In your request, please include:

(1) your name and, your medical record number
(2) your medical condition or symptom
(3) the specific prescription drug or supply that you are requesting, and
(4) the specific reason(s) for your request that we review our initial decision.

We must receive your request within 180 days of your receiving the notice of our adverse benefit determination.  Please note that we will count the 180 days starting 5 business days from the date of the notice to allow for mail delivery time, unless you can prove that you received the notice after that 5 business day period.

A decision about your appeal will be made within 30 days of receipt of your request for review at each level unless we inform you otherwise in advance.

If you disagree with our decision on your first level appeal, your first level appeal adverse decision notice will tell you how to submit a second level appeal.

Appointment of a Representative

If you would like to have someone act on your behalf during our review, you may appoint an authorized representative.  You must make this appointment in writing.  Please send the name, address and telephone contact information to KPIC Pharmacy Administrator Grievance and Appeals Coordinator at the address set forth above.

If you want to review the information that we have collected regarding your claim for this service, you may request, and we will provide without charge, copies of all relevant documents, records, and other information.

You may send us additional information including comments, documents, or additional medical records which you believe supports your claim.  If we had asked for additional information before and you did not provide it, we would still like to have that additional information for our review.  Please send all your additional information to:

KPIC Pharmacy Administrator
Grievance & Appeals Coordinator
10181 Scripps Gateway Court 
San Diego, CA 92131
(800) 788-2949

Or you can fax the letter to (858) 790-6060 Attn: KPIC Pharmacy Administrator Grievance and Appeals Coordinator

In addition, you may give testimony in writing or by telephone.  Please send your written testimony to KPIC Pharmacy Administrator Grievance and Appeals Coordinator at the address set forth above.  To arrange to give testimony by telephone, you should contact KPIC Pharmacy Administrator Grievance & Appeals Coordinator at the telephone number above. We will add all of the new information to your claim file and we will review it without regard to whether this information was submitted and/or considered in our initial decision.

We will share any additional information that we collect in the course of our review by sending it to you in advance of our decision.   If we believe on review that your request should not be granted, before we issue our final decision, we will also share with you in writing any new or additional reasons for that decision.  We will send you a letter explaining the new or additional information and/or reasons.  Our notices will tell you how you can respond to the information provided if you choose to do so.  If you do not respond before we must make our final decision, that decision will be based on the information already in your claim file.

Should you have any questions regarding your appeal rights, please contact KPIC Pharmacy Administrator Grievance and Appeals Coordinator at (800) 788-2949.

Non-Contracted Pharmacies

• Non-contracted pharmacies are not covered under this insurance plan.
• Prescriptions from non-contracted providers may be brought into a Kaiser Permanente Pharmacy (per details below: “How to save money on prescriptions”).