Our pharmacy services team provides you with pharmacy benefits that show how much we care about the health and safety of you and your family. We thank you for the opportunity to support your prescription needs.
Our network lets you choose when and how to get your prescription drugs. We have contracts with over 63,000 pharmacies throughout the U.S., including retail pharmacies, home infusion, long-term care, Indian health service pharmacies, and specialty and mail-order pharmacies.
Use our online directory to find a pharmacy in our network. You may request a printed directory by emailing phipquestions@modahealth.com. You can also download a pharmacy directory below.
Our formulary is our list of covered prescription drugs. You can use it to see what generic and brand-name drugs are covered under our plan. Please note this formulary may change (see our formulary updates section below to view changes). If you do not see the drug you are looking for, please call our pharmacy customer service at the number listed below. That drug may be covered. You can also contact pharmacy customer service to request a printed copy of the formulary.
Changes to the formulary may include:
We will send you a notice if we make changes to a drug you're using.
With this tool you can:
Follow these steps to use the online tool:
*Prescription drug information displayed on the online benefit tool is subject to change without notice and is not a guarantee of benefits. Your coverage is based on your plan benefit and eligibility at the time of service. If you have copay assistance, it may affect your maximum out-of-pocket amount. Coverage and cost sharing may vary for preventive services.
We may be able to cover a drug for you if you ask us to make an exception. You can request an exception if:
To request an exception, you or your provider may do one of the following:
Learn more about making an appeal in your Evidence of Coverage
If you get a prescription filled at an out-of-network pharmacy for one of the reasons below, you can request to be reimbursed. Our decisions on reimbursement are based on your Evidence of Coverage (EOC).
Circumstances for out-of-network prescription coverage:
Follow these steps to submit a claim:
We're here to help. Please call our Moda Health Pharmacy Customer Service team at 888-786-7509 (TTY users, dial 711). Our regular business hours are 7 a.m. to 8 p.m., Pacific time, seven days a week from Oct. 1 to March 31. After March 31, your call will be handled by our automated phone system on Saturdays, Sundays and holidays).
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Producer DashboardWe have exciting news to share. ODS is changing its name to Moda Health.
Moda comes from the latin term "modus" and means "a way". We picked it because that's what we are here to do: help our communities find a way to better health.
Together, we can be more, be better.
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