Beginning January 1, 2027, your share of the cost for some medicines given to you in a medical office will change. This includes certain shots and IVs that you get from a doctor or nurse at an office or infusion center. Today, you pay $0 for these medicines. In 2027, you will pay your coinsurance, which is a percentage of the cost. Some plans also have a deductible. If your plan has one, you may need to meet it before coinsurance starts.
Here are some examples of medicines that you will pay a coinsurance for:
- Certain autoimmune/immunodeficiency medications including Infliximab (Inflectra), Immune Globulin (Gammagard), Abatacept (Orencia), and Vedolizumab (Entyvio)
- Certain cancer medications including Pembrolizumab (Keytruda), fam-trastuzumab deruxtecan-nxki (Enhertu), and Pertuzumab (Perjeta)
- Certain tumor medications including Lanreotide (Somatuline) and Octreotide (Sandostatin LAR Depot)
- Certain behavioral health medications including Paliperidone Palmitate (Invega Sustenna)
- Certain neurotoxins including Botulinum toxin (Botox) for non-cosmetic purposes
As drug costs continue to rise, this change will help keep monthly premiums affordable for our members. We understand that members who need one of the medicines affected will have higher out-of-pocket expenses. We are here to help in any way we can.
How it works
Starting in 2027, when you have a visit to get one of these medicines from a doctor or nurse, you’ll get a bill for it after your visit. If your plan has a deductible, you’ll pay the full cost until you reach the deductible. After that, you’ll pay your plan’s coinsurance. The coinsurance you pay will count towards your out-of-pocket maximum. Once your out-of-pocket maximum is reached, you will pay nothing for your medical care for the rest of the calendar year.
To learn more about the costs of specific clinically administered medications or to learn more about our Medical Financial Assistance Program (MFA), you can call patient financial services at 404-949-5112 (TTY: 1-800-255-0056) Monday through Friday, 8:30 a.m. to 4:30 p.m. For other questions, just call Member Services at (404) 261-2590 (TTY: 711), Monday through Friday from 7 a.m. to 7 p.m. We value your membership with Kaiser Permanente and are here to help.