Kaiser Permanente policy change restricts medications

COLFAX - Health insurance provider Kaiser Permanente made a policy change, that took effect this year, which is limiting where some patients can get their prescriptions filled.

Colfax patients who are insured through Kaiser Permanente have been reported saying that they are unable to get their maintenance medicine at Tick Klock Drug located in Colfax due to the new rule.

Third generation Tick Klock owner and pharmacist Nathan Johnson, stated that the pharmacy is in the the Kaiser Permanente network, but Kaiser Permanente has mandated that most of their insurers have to go through mail order for maintenance medications.

"It's a list of medications that Kaiser deems as maintenance," Johnson explained, adding that maintenance medications are ones that patients routinely get for their chronic conditions.

Maintenance drugs are prescriptions that are usually taken regularly, and those with chronic conditions use these medicines on a daily basis. Some examples of conditions that maintenance drugs are used to treat are high blood pressure, heart disease, asthma and diabetes.

According to Johnson Kaiser Permanente claim that it is to increase patient care.

Kaiser Permanente were unable to be reached at time of press, but are reported to have sent a statement to NonStop Local KHQ news responding to concerns to their pharmacy policy change.

"Kaiser Permanente is committed to ensuring our members continue to have access to their medications. In the rare event a member's prescription does not reach their home, a specially trained pharmacy staff member will work with the impacted member to assist with a time sensitive supply of medication at a network pharmacy," they say in their statement.

Representative Joe Schmick explained that some of this policy change was due to a decision made last year by the Public Employee Benefit Board (PEB), and the School Employee Board (SEB) to be associated with those plans.

Schmick explained that if the public schools in the county decided to use a plan they have to abide by the decision the two boards have made.

"In 2022, the decision was made by those two boards that if you're going to use Kaiser Permanente where you get your prescriptions they were going to force people to use mail-order," Schmick said.

The schools that chose the plan then told their employees that they would only be allowed to get their drugs through mail, and not at their local pharmacy, Schmick explained.

"I have a problem with that. I believe that the patient needs to be able to make the choice what is best for them, and I disagree with the mail order only prescriptions."

Johnson would agree, stating that the main thing the pharmacy wants is their patients to have freedom of choice when it comes to the pharmacy they use.

"We're just trying to make them aware of what their options are," Johnson said, adding that they can try to call their insurance provider, but the pharmacy will work with prices when the customers insurance can't be billed.

"They can still get their medications here, hopefully at a price that is affordable to them," he said, adding that customers can also reach out to the insurance commissioner and file a complaint with their insurance.

Tick Klock is not giving up on providing for all of their customers, "It doesn't matter what insurance they have," Johnson said, "We're gonna try to go above and beyond."