|
Click here to download this page as a
Word document.
CommunityRx Kansas
Click here for the CommunityRx Kansas - PNK enrollment form.
Prescription Network of Kansas is pleased to offer CommunityRx Kansas to all Kansans who qualify for the program. Following is the plan information for CommunityRx Kansas as offered through PNK:
Covered Medications
See the Medication List / Payment Tiers for a list of the covered medications under this program. The medications listed are the only medications covered. In addition, they are available only in the strength(s) listed. Only generic medications are covered through this program.*
Quantity / Days Supply Limitations
Any of the covered medications can be dispensed in any quantity, not to exceed a 90 days supply. Please be aware that the pharmacy has to dispense the medication as ordered by your physician on the prescription. Your physician has to write the prescription to allow the pharmacy to dispense a 90 days supply if that is the quantity you want.
Your Cost
You will pay the amount listed in each section as the total cost of the medication. This is not an insurance program. The payment you make to the pharmacy is the only payment they will receive for the prescription.
Participating Pharmacies
Contact the Prescription Network of Kansas office at 1-800-279-3022 to find out if a particular pharmacy participates in this program. This program is available only at pharmacies in the state of Kansas. If you received this information directly from a pharmacy, then it is most likely that pharmacy participates in the PNK portion of this program.
Enrollment
To qualify for this program you must meet the criteria outlined on the program Enrollment Form. If you meet this criteria, complete the Enrollment Form and return the form, with any applicable fee, to Beyond-Rx (the address is provided on the Enrollment Form). Once your enrollment is processed you will receive an identification card and additional information from our office. At that time you may begin using the program and have the covered medications filled for the price listed.
*PNK reserves the right to remove medications from this list or move covered medications from one payment level to another, due to market price changes. Any coverage or payment changes will occur no more often than once each calendar quarter. Network pharmacies will be notified of any changes.
CommunityRx Kansas
Medication List / Payment Tiers
TIER 1 Cost = $8.00 UP TO 90 DAYS SUPPLY
Medication |
Compare To |
Allopurinol 100mg, 300mg |
Zyloprim |
Amitriptyline 10mg, 25mg, 50mg, 75mg, 100mg |
Elavil |
Atenolol 25mg, 50mg, 100mg |
Tenormin |
Atenolol/Chlorthal 50/25mg, 100/25mg |
Tenoretic |
Benazepril 5mg |
Lotensin |
Bisoprolol/HCTZ 2.5-6.25mg, 5-6.25mg, 10-6.25mg |
Ziac |
Captopril 12.5mg, 25mg, 50mg |
Capoten |
Doxazosin 1mg, 2mg, 4mg, 8mg |
Cardura |
Enalapril 2.5mg, 5mg, 10mg, 20mg |
Vasotec |
Estradiol 0.5mg, 1mg, 2mg |
Estrace |
Fluoxetine 10mg, 20mg |
Prozac |
Folic Acid 1mg |
Folacin |
Furosemide 20mg, 40mg, 80mg |
Lasix |
Glipizide 5mg, 10mg |
Glucotrol |
Glyburide 1.25mg, 2.5mg, 5mg |
Micronase, Diabeta |
Glyburide Micronized 1.5mg, 3mg, 6mg |
Glynase Prestab |
HCTZ 25mg, 50mg |
Microzide |
Indapamide 1.25mg, 2.5mg |
Lozol |
Medroxyprogesterone 2.5mg, 5mg, 10mg |
Provera |
Nortriptyline HCl 25mg, 50mg, 75mg |
Pamelor |
Oxybutinin 5mg |
Ditropan |
Prednisone 2.5mg, 5mg, 10mg, 20mg |
Deltasone |
Propranolol 10mg, 20mg, 40mg |
Inderal |
Triamterene/HCTZ 37.5-25mg, 50-25mg |
Dyazide |
Triamterene/HCTZ 75-50mg |
Maxide |
PNK reserves the right to remove medications from this list or move covered medications from one payment level to another, due to market price changes. Any coverage or payment changes will occur no more often than once each calendar quarter. Network pharmacies will be notified of any changes.
TIER 2 Cost = $14.00 UP TO 90 DAYS SUPPLY
Drug |
Compare To |
Albuterol 90mcg inhaler |
Proventil |
Benazepril/HCTZ 5-6.25mg, 10-12.5mg, 20-12.5mg, 20-25mg |
Lotensin HCT |
Benztropine 0.5mg, 1mg, 2mg |
Cogentin |
Buspirone 5mg, 10mg |
Buspar |
Digoxin 0.125mg, 0.25mg |
Lanoxin |
Famotidine 20mg, 40mg |
Pepcid |
Ibuprofen 400mg, 600mg, 800mg |
Motrin |
Isosorbide Mono ER 30mg, 60mg, 120mg |
Imdur |
Lisinopril 2.5mg, 5mg, 10mg, 20mg, 30mg, 40mg |
Prinivil, Zestril |
Lisinopril/HCTZ 10-12.5mg, 20-12.5mg, 20-25mg |
Prinzide, Zestoretic |
Metoclopramide 10mg |
Reglan |
Metoprolol 25mg, 50mg, 100mg |
Lopressor |
Nadolol 20mg, 40mg |
Corgard |
Naproxen 250mg, 375mg, 500mg |
Anaprox, Naprosyn |
Ranitidine 150mg, 300mg |
Zantac |
Terazosin 1mg, 2mg, 5mg, 10mg |
Hytrin |
Trazodone 50mg, 100mg, 150mg |
Desyrel |
TIER 3 Cost = $26.00 UP TO 90 DAYS SUPPLY
Drug |
Compare To |
Albuterol 2mg, 4mg |
Proventil |
Benazepril 10mg, 20mg, 40mg |
Lotensin |
Bumetanide 1mg, 2mg |
Bumex |
Buspirone 15mg |
Buspar |
Carbamazepine 200mg |
Epitol |
Carbamazepine Chew 100mg |
Epitol |
Citalopram 10mg, 20mg, 40mg |
Celexa |
Clonidine 0.1mg, 0.2mg, 0.3mg |
Catapres |
Glipizide ER 2.5mg, 5mg |
Glucotrol XL |
Glybur/Metform 1.25-250mg, 2.5-500mg, 5-500mg |
Glucovance |
Labetalol 100mg |
Normodyne |
Levothyroxine 25mcg, 50mcg, 75mcg, 88mcg, 100mcg, 112mcg, 150mcg, 175mcg, 200mcg |
Levo-T, Unithroid, Eltroxin |
Lovastatin 10mg |
Mevacor |
Metformin 500mg, 850mg, 1000mg |
Glucophage |
Metformin ER 500mg |
Glucophage XR, Fortamet |
Mirtazapine 15mg, 30mg |
Remeron |
Pentoxifylline 400mg |
Trental |
Potassium Chloride 10mEq, 20mEq |
K-Dur |
Prazosin 1mg |
Minipress |
Sotalol 80mg |
Betapace |
Spironolactone 25mg |
Aldactone |
Tamoxifen 10mg, 20mg |
Nolvadex |
Ticlopidine 250mg |
Ticlid |
Verapamil 40mg, 80mg, 120mg |
Calan |
Warfarin 1mg, 2mg, 2.5mg, 3mg, 4mg, 5mg, 6mg, 7.5mg, 10mg |
Coumadin |
PNK reserves the right to remove medications from this list or move covered medications from one payment level to another, due to market price changes. Any coverage or payment changes will occur no more often than once each calendar quarter. Network pharmacies will be notified of any changes.
|