Specialty Pharmacy Benefits
- What are specialty medications?
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Specialty medications are often prescribed to treat complex chronic health conditions and require special handling techniques, careful administration, and an individualized ordering process. Details about our clinical services and a list of specialty medications can be accessed on the OEBB-specific Moda Health website, through the Member Dashboard, or by contacting the Moda 360 Health Navigator team at 866-923-0411.
Any new specialty drug approved by the Food and Drug Administration (FDA) is not covered until approved by Moda Health.
- Where should I get specialty medications (e.g., self-injectables, biologics, various other medications)
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Specialty medications must be accessed through the exclusive specialty pharmacy. These prescriptions may be limited to a 31-day supply and require prior authorization. You can get information on your plan's coverage and out-of-pocket costs by clicking the Pharmacy tab in the Member Dashboard or by calling the Moda 360 Health Navigator team at 866-923-0411.
Ardon Health Specialty Pharmacy (Ardon) is the preferred specialty pharmacy for OEBB members. Contact information for Ardon is at https://www.ardonhealth.com/about-us/contact-us.shtml, but Moda 360 Health Navigators can help with many questions.
- How do I get started with the exclusive specialty pharmacy?
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Ardon Health Specialty Pharmacy is the exclusive specialty pharmacy for OEBB members with Moda plans. Ardon can enroll you into the program over the phone, by contacting your physician for prescription information, or by transferring an existing prescription from another pharmacy. To contact Ardon, visit https://www.ardonhealth.com/about-us/contact-us.shtml.
- What can I do if I am unable to fill my prescription before I run out of medication?
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If you run out of your specialty medication before you can get set up with the exclusive specialty pharmacy, call the Moda 360 Health Navigator team at 866-923-0411. A Health Navigator will work closely with you, your provider, and the exclusive specialty pharmacy to help you get the medication.
- What if I can't afford my specialty copay?
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The specialty pharmacy will research available financial assistance programs to see if there is any support available to you. If a program is identified, the pharmacy will work with you to apply for financial assistance.
- How can I pay for my specialty prescription order?
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When you schedule your order, you can payby credit card, debit card or check. All payments must be made before the product is shipped.
- How will my specialty order be shipped?
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If your medication is refrigerated, your order will be shipped via overnight delivery in special packaging to ensure the product remains refrigerated. If your medication does not require refrigeration, the exclusive specialty pharmacy will ship it to ensure it is delivered on the date the order is requested to be received.
The specialty pharmacy will also ship, with your order, any additional supplies you may need in order to administer your medication, such as syringes, alcohol swabs and sharps containers.
- How much of my specialty medication will be shipped to me each time?
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Your benefit authorizes up to a 31-day supply of most specialty medications. However, you may be able to receive up to a 90-day supply of certain specialty medications when allowed.
- Why am I limited to a 31-day supply for most specialty medications?
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The Moda Health Specialty Drug Program provides payment for up to a 31-day supply of most specialty medications to avoid waste resulting from abrupt discontinuation. A medication can be discontinued for many reasons, including:
- Intolerable side effects
- Less-than-ideal results from the medication
- Dangerous changes in laboratory results
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