1020 SW Fairlawn Road, Topeka, KS  66604  |  Ph: 785.228.1695  Toll Free: 800.279.3022 Fax: 785.228.9147












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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.


 

Click here for the CommunityRx Kansas - PNK enrollment form.