The Moda Health Preferred Drug Program offers a choice of medications that are effective treatments and provide value to Moda Health pharmacy members by saving them money on prescription drug costs.

Search our formulary to see medications by tier and coverage level. For specific questions related to these documents, please call Moda Health Pharmacy Services at 844-235-8017.

For member specific answers to questions, and to determine which PDL applies to your patient, please log in to Benefit Tracker or call Moda Health Pharmacy Services at 844-235-8017.

How does the program work?

This program uses a tiered copay system. Members and their doctors can choose between value tier, generic (tier 1), preferred (tier 2) or brand (tier 3) drugs. Each tier has a different copay amount and will depend on the member’s benefit. Refer to the Member Handbook for specific tier and coverage information. To determine which PDL applies to your patient, please log into Benefit Tracker.

Who makes decisions about drugs on the Preferred Drug List?

The list is developed and maintained by a committee comprised of doctors and pharmacists called the Pharmacy and Therapeutics Committee. The committee makes decisions based on information about the drug’s safety, effectiveness and associated clinical outcomes.

What makes the Moda Health Preferred Drug Program different?

Moda Health offers more flexibility; members can choose high-cost drugs if they want to and still have a portion of the costs paid by Moda Health. Many formularies require you to use the generic or low-cost brand drugs listed on their formulary and will not pay for any high-cost drugs not on that list.

Does the tiered drug program limit which drugs physicians can prescribe?

This list is not meant to replace a doctor’s judgment for prescribing decisions. The Moda Health Preferred Drug Program is designed to offer cost-effective choices that will save members money on prescription drugs. Moda Health does not take responsibility for any drug decisions made by the prescriber or dispensing pharmacist.

What if a prescribed drug is not listed on the chart?

The Moda Health Preferred Drug List is not an all-inclusive list. Generic drugs that do not appear on the list will be paid at the generic (tier 1) copay. Brand drugs that do not appear on this list that do not have less expensive brand or generic alternatives will be paid at the preferred (tier 2) copay. Drugs that are new to the market and not on the list will not be covered until reviewed by the Pharmacy and Therapeutics Committee. For more information on new drugs to the market, please call Moda Health Pharmacy Customer Service.

How will diabetic drugs and supplies be covered?

Please check your Member Handbook for specific coverage of diabetic supplies. Abbott and Bayer diabetic supplies are the Moda Health preferred (tier 2) products. In addition, a free blood glucose meter is available for the preferred meters (Abbott or Bayer). For more information about this program please call Moda Health Pharmacy Customer Service.

Can members get brand drugs for a generic copayment?

If a member requests a brand name drug or the prescribing physician prescribes a brand name drug when a generic equivalent is available, the member will be responsible for the brand copayment plus the difference in cost between the generic and the brand name drug. Members should consult their Member Handbook for specific coverage information.

How do members use their mail-order benefit?

Members may obtain a 90-day supply per prescription through our mail-order pharmacy. Special mail-order pharmacy forms are available for members in their Member Dashboard account. Members should refer to their Member Handbook for copayment information.

When is the three-tier drug list updated?

Modifications to the list reflecting new drugs or changes in treatment patterns will be made throughout the year. When a generic becomes available for a brand name medication, the brand name drug will be moved to the Brand Tier (3).