Loading...

Find a Prescription Drug

The KelseyCare Advantage plan uses a Drug Formulary. A formulary is a list of covered drugs selected by KelseyCare Advantage in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. KelseyCare Advantage will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a KelseyCare Advantage network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage (Member Handbook).

To determine whether your medications are on our Formulary, you may search the formulary by drug name, drug category, or by the first letter of the drug name.

Loading...

Prescription Drug Temporary Transition Supply

Under certain circumstances, the plan can offer a temporary supply of a drug when your drug is not on the Drug List or when it is restricted in some way. Click here for more information.

Drug Search - See if your drug is covered

Click here to search the 2012 KelseyCare Advantage Formulary.
Loading...

Schedule of Copayment and Deductibles for Prescription Drugs

KelseyCare Advantage and Catalyst Rx provide drug coverage similar with the benefits designed by Employees Retirement System of Texas (ERS).  See blow for a comparison to HealthSelect.

30-Day Supply
KelseyCare
Tier
HealthSelect
Tier
Non-Maintenance Maintenance
1 & 2 1 $15 $20
3 2 $35 $45
4 & 5 3 $60 $75

90-Day Supply
KelseyCare
Tier
HealthSelect
Tier
Non-Maintenance Maintenance
1 & 2 1 $45 $45
3 2 $105 $105
4 & 5 3 $180 $180

All Maintenance Medications for Insulin, Diabetic Drugs, and Contraceptives
KelseyCare
Tier
HealthSelect
Tier
30-Day Supply 90-Day Supply
1 & 2 1 $15 $45
3 2 $35 $105
4 & 5 3 $60 $180

 
Tier 1 30-Day Supply 90-Day Supply
Disposable
Syringes for
Insulin
$35 $105
Alcohol Pads and
Gauze
20% 20%

Loading...

Mail Order Service

As part of your plan, you now have access to Catalyst Mail, a convenient, quality-focused, and easy-to-use prescription mail service program.  This program enables you to receive up to a 90-day supply of prescription medications delivered right to your door.  To get started with Catalyst Mail, please click here to view the process for obtaining prescriptions through this program. You may also download the Mail Order form.

Loading...

Formulary Addendum/Changes

The formulary may change during the year. Click here to review and/or print formulary changes made in 2011 and click here for 2012 changes. If you would like to request a copy of the formulary addendum to be mailed to your home, please call Member Services at (713) 442-2ERS (2377) or (877) 853-9075, 8 a.m. to 5 p.m., Monday through Friday. TTY/TDD users should call (866) 302-9336.

Loading...

Customer Service Contact Information

Catalyst Rx Customer Service is available 24 hours a day, 7 days a week.  You can call them toll-free at (866) 589-5222 (TTY/TDD (888) 206-8041).

Loading...

Documents for Download

  • Prior Authorization Criteria PDF  PDF 2012
  • Step Therapy Criteria PDF  PDF 2012
  • Quantity Limit Amounts PDF  PDF 2012 
  • Abridged Formulary PDF  PDF 2012 
  • Comprehensive Formulary PDF  PDF 2012 
  • Pharmacy Directory PDF  PDF 2011 En Español PDF PDF 2011 (Coming Soon) 
.
Privacy Notice   |   Our Mission   |   Contact Us
8900 Lakes at 610 Dr., Suite 1100, Houston, TX 77054
Hours of Operation: 8 a.m. - 5 p.m., Monday - Friday
(713) 442-2ERS (2377)  /  TTY/TDD: (866) 302-9336
©2009 KelseyCare Advantage. All rights reserved.
Last Updated: 10/1/11