Kaiser Permanente of WA removes First Fill, other benefit changes for public and school employees

Kaiser Permanente of Washington implemented a controversial program in early 2023, requiring members to refill maintenance medications through a Kaiser Permanente pharmacy or mail order service after filling the first prescription at a network pharmacy. 

The company has now removed that requirement. Letters sent by the Public Employee Benefit Board and School Employee Benefit Board, who account for two of the company’s major membership groups, informed customers the program would be removed.

The change had caught many Kaiser Permanente customers off-guard, including Kathryn Jackson, who spoke with NWPB in February about First Fill. She said she planned to change her medical plan in 2024 because of the requirement.

“I have a lot of options for health care through my employer, and maybe I’ll just change it,” Jackson said in February. “But that open enrollment only happens the month of November. So, now, I have to wait almost a whole year if I want to change.”

Kaiser members can now refill maintenance medications at any network pharmacy.

In a follow-up email, Jackson said between the surprise change in her prescription refills and other challenges she had with the company, she still planned to switch to a different insurance provider.

Other changes for people who get their insurance under both PEBB and SEBB will for many include higher premiums.

The changes, effective January 1 of 2024, will affect state agency and higher education employees, Medicare and non-Medicare public employee retirees, school employees and dependents on their plans. 

Open enrollment for school employees begins Oct. 30 through Nov. 20, 2023, and for public employees, Nov. 1 through 30.

Both PEBB and SEBB plans will see an increase in the annual maximum contribution for health savings accounts to $4,150 for single subscribers, and $8,300 for families. Both plans will also see an increase in the maximum annual contribution for untaxed Medical Flexible Spending Arrangements, which are used to pay for out-of-pocket health care costs, up to $3,050.

Non-Medicare PEBB plans will see an increase in the minimum deductible for high-deductible health plans to $1,600 for single subscribers and from $3,200 for families. The change will affect consumer-directed health plans (CDHPs).

Kaiser Permanente, the Uniform Medical Plan and Premera Blue Cross, will all allow members to use hearing aid benefits of up to $3,000 per ear, every three years.

Under Kaiser Permanente of Washington, copays for many services are expected to change. 

More details about new changes approved by the Public Employee Benefit Board are available here and changes approved by the SEBB here.