Services needed because of a workplace-related illness or injury that the Office of Workers’ Compensation Programs (OWCP) or a similar Federal or State agency determines they must provide; or OWCP or a similar agency pays through a third party injury settlement or other similar proceeding that is based on a claim you filed under OWCP or similar laws Oncology Radiation therapy, chemotherapy, oral chemotherapy. Radiation Therapy and Chemotherapy: After Deductible, Enrollee pays $30 primary care See Infusion Therapy for infused medications. provider services Copayment or $50 specialty care provider services Copayment Oral Chemotherapy Drugs: Value based medications which provide significant value in treating chronic disease as determined by KFHPWA (Please contact Kaiser Permanente Member Services for a list of medications): Enrollee pays $5 Copayment Preferred generic drugs (Tier 1): Enrollee pays $25 Copayment per 30-days up to a 90-day supply Preferred brand name drugs (Tier 2): After Prescription Drug Deductible, Enrollee pays $50 Copayment per 30-days up to a 90-day supply Non-Preferred generic and brand name drugs (Tier 3): After Prescription Drug Deductible, Enrollee pays 50% coinsurance per 30-days up to a 90-day supply Preferred specialty brand name drugs (Tier 4): After Prescription Drug Deductible, Enrollee pays $150 Copayment up to a 30-day supply Non-Preferred specialty brand name drugs (Tier 5): After Prescription Drug Deductible, Enrollee pays 50% coinsurance up to $400 maximum up to a 30-day supply Optical (vision) Routine eye examinations and refractions, limited to once Routine Exams: After Deductible, Enrollee pays every 12 months. $30 primary care provider services Copayment or $50 specialty care provider services Copayment Eye and contact lens examinations for eye pathology and to monitor Medical Conditions, as often as Medically Exams for Eye Pathology: After Deductible, Necessary. Enrollee pays $30 primary care provider services Copayment or $50 specialty care provider services Copayment PEBB_VA_2024 34